Auto-Placement by Service Code

DISCLAIMER

This feature is enabled and managed by Payers (MCOs) and available to Members of a participating Payer network. To determine eligibility, the Member’s Medicaid ID and/or the First Name, Last Name, and DOB must match the Payer system.

The Auto-Placement by Service Code feature allows Providers to schedule and bill for services that do not require prior Payer authorization. When this feature is enabled by the Payer, the Allow Auto Placement checkbox field displays selected in the Contract Service Code window (Admin > Reference Table Management > Contract Service Code) as read-only.

Contract Service Code: Auto Placement Field

Payers provide a list of eligible Service Codes that can be used to perform an Auto Placement. Refer to the Payer Eligible Service Codes section. Once the Service Code is created and synced from the Payer system, Providers can create a new contract for a Patient.

Complete the following steps to create an Auto Placement for a Member.

Step	Action
1	Navigate to Member > Member Search to locate the Member. If a Member does not exist in the system, then navigate to Member > New Member to create a New Member Profile. Refer to the New Patient section in the Enterprise Help Portal for guidance and requirements. Note: The Medicaid Number MUST be entered for a successful placement.
2	Select the Contracts link from the index to open the Contracts page. On the Contracts page, click on the Add button to add a contract. Patient Contracts Page: Add Contract
3	On the Contracts window, complete the required fields (Contract and Service Start Date) as well as the optional fields to include the applicable Service Code. Click Save. Send Auto Placement
4	Once saved, the Contract appears in the Contract page, pending the Alt. Patient ID. Allow a few seconds, for the system to refresh. Click on the Refresh Page button to refresh, as needed. Patient Contracts Page: Send Auto Placement Menu Option
5	A populated Alt. Patient ID indicates a successful auto placement. When an auto placement is submitted, the system validates the Patient information (such as Patient Name, Medicaid ID, etc.) against the Payer Member data. Once verified, a placement confirmation is sent to the Provider. Alt. Patient ID – Successful Auto Placement
6	If a diagnosis code is required on the claim, then add it on the Patient contract or on the invoice. Refer to the Payer Eligible Service Codes section for Payer-specific requirements. For more information on entering diagnosis codes, refer to the Provider-Managed Billing Diagnosis Codes Job Aid.

Payer Eligible Service Codes

The following tables include the eligible Service Codes per participating Payer.

AmeriHealth EPSDT (28162)

Diagnosis Code must be added to Patient contract.

Service Code	Description	Service Code	Description
92551	Screening Test, Pure Tone, Air Only	G0153	Speech Therapy (Day 1-28) by a ST
92552	Pure tone audiometry (threshold); Air Only	G0153UD	Speech Therapy (Day 29 and beyond) by a ST
99500AT	Home Visit Prenatal (Non HBP) Assessment	G0154	HHCP - Svs of RN, EA 15 Mins
99501AT	Home Visit Postnatal (Non HBP) Follow-up Care	G0155	Social Worker
99501ATGT	Home Visit Postnatal (Non HBP) Follow-up Care Audio/Video	G0299	Dir SNS RN HH/Hospice Set
G0108	Diabetes Outpatient Training Service, individual	G0299UB	Dir SNS RN HH/Hospice Set - UB
G0109	Diabetes Outpatient Training, group	G0299U8	HHA visit to a patient's home (Day 1-28) by a RN
G0151	Physical Therapy (Day 1-28) by a PT	G0299U8UD	HHA visit to patient's home (Day 29 and beyond) by a RN
G0151UD	Physical Therapy (Day 29 and beyond) by a PT	G0300U8	HHA visit to a patient's home (Day 1-28) by a LPN
G0151U8	HHCP-SERV OF PT, EA 15 Mins	G0300U8UD	HHA visit to patient's home (Day 29 and beyond) by a LPN
G0152	Occupational Therapy (Day 1-28) by an OT	G0300	Dir SNS LPN HH/Hospice Set
G0152UD	Occupational Therapy (Day 29 and beyond) by an OT	G0300UB	Dir SNS LPN HH/Hospice Set - UB
G0152U8	HHCP-SERV OF OT, EA 15 Mins

AmeriHealth Caritas of North Carolina HHCS (57537)

Diagnosis Code must be added to Patient contract.

Service Code	Description	Service Code	Description
97161	PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS	97165	OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
G0151	Physical Therapy	G0152	SRVC OT HOM HLTH/HOSPICE EA 15 MIN
G0157	PT Assistant	G0158	SRVC OT ASSIST HH/HOSPICE EA 15 MIN
G0159 RC420	SRVC PT HH EST/DEL PT MP EA 15 MINS	G0160 RC430	SRVC OT HH EST/DEL OT MP EA 15 MIN
G0159 RC424	SRVC PT HH EST/DEL PT MP EA 15 MINS	G0160 RC434	SRVC OT HH EST/DEL OT MP EA 15 MIN
92521	EVALUATION OF SPEECH FLUENCY	G0153	SRVC SPCHANDLANG PATH HH/HOSPIC EA 15
92522	EVALUATE SPEECH PRODUCTION	G0161	SRVC SLP HH EST/DEL SLP TX MP 15 MN
92523	SPEECH SOUND LANG COMPREHEN	G0283	E-STIM 1/>NOT WND CARE PART TX PLAN
97162	PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS	G2168	Services performed by minutes
97163	PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS	G2169	SERVICES PRFRM BY OT ASST HH SETTING EA 15 MIN
97164	PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS	S9128	SPEECH THERAPY IN THE HOME PER DIEM
97166	OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS	S9129	OCCUPATIONAL THERAPY HOME PER DIEM
97167	OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS	S9131	PHYSICAL THERAPY HOME PER DIEM
97168	OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS

Carolina Complete Health HHCS (57535)

Diagnosis Code must be added to the Invoice Details page.

Service Code	Description	Service Code	Description
G0159	SRVC PT HH EST/DEL PT MP EA 15 MINS	G0162	SKILLED SRVC RN MANDE POC EA 15 MINS
G0160	SRVC OT HH EST/DEL OT MP EA 15 MIN	G0493	RN CARE EA 15 MIN HH/HOSPICE
G0161	SRVC SLP HH EST/DEL SLP TX MP 15 MN	G0494	LPN CARE EA 15MIN HH/HOSPICE

Keystone EPSDT (28164)

Diagnosis Code must be added to Patient contract.

Service Code	Description	Service Code	Description
92551	Screening Test, Pure Tone, Air Only	G0153	Speech Therapy (Day 1-28) by a ST
92552	Pure tone audiometry (threshold); Air Only	G0153UD	Speech Therapy (Day 29 and beyond) by a ST
99500AT	Home Visit Prenatal (Non HBP) Assessment	G0154	HHCP - Svs of RN, EA 15 Mins
99501AT	Home Visit Postnatal (Non HBP) Follow-up Care	G0155	Social Worker
99501ATGT	Home Visit Postnatal (Non HBP) Follow-up Care Audio/Video	G0299	Dir SNS RN HH/Hospice Set
G0108	Diabetes Outpatient Training Service, individual	G0299UB	Dir SNS RN HH/Hospice Set - UB
G0109	Diabetes Outpatient Training, group	G0299U8	HHA visit to a patient's home (Day 1-28) by a RN
G0151	Physical Therapy (Day 1-28) by a PT	G0299U8UD	HHA visit to patient's home (Day 29 and beyond) by a RN
G0151UD	Physical Therapy (Day 29 and beyond) by a PT	G0300U8	HHA visit to a patient's home (Day 1-28) by a LPN
G0151U8	HHCP-SERV OF PT, EA 15 Mins	G0300U8UD	HHA visit to patient's home (Day 29 and beyond) by a LPN
G0152	Occupational Therapy (Day 1-28) by an OT	G0300	Dir SNS LPN HH/Hospice Set
G0152UD	Occupational Therapy (Day 29 and beyond) by an OT	G0300UB	Dir SNS LPN HH/Hospice Set - UB
G0152U8	HHCP-SERV OF OT,EA 15 Mins

UnitedHealthcare of Pennsylvania (27773)

Diagnosis Code must be added to Patient contract.

Service Code	Description	Service Code	Description
92551	Screening Test, Pure Tone, Air Only	G0153	Speech Therapy (Day 1-28) by a ST
92552	Pure tone audiometry (threshold); Air Only	G0153:UD	Speech Therapy (Day 29 and beyond) by a ST
99500:AT	Home Visit Prenatal (Non HBP) Assessment	G0154	HHCP - Svs of RN, EA 15 Mins
99501:AT	Home Visit Postnatal (Non HBP) Follow-up Care	G0155	Social Worker
99501:AT:GT	Home Visit Postnatal (Non HBP) Follow-up Care Audio/Video	S9127	Social Work Visit, In the Home, Per Diem
G0108	Diabetes Outpatient Training Service, individual	S9128	Speech Therapy, In the Home
G0109	Diabetes Outpatient Training, group	S9129	Occupational Therapy, In the Home
G0151	Physical Therapy (Day 1-28) by a PT	S9131	Physical Therapy, In the Home
G0151:UD	Physical Therapy (Day 29 and beyond) by a PT	T2025:GN	Speech/Language Therapy-15 Mins
G0151:U8	HHCP-SERV OF PT, EA 15 Mins	T2025:GO	Occupational Therapy-15 Mins
G0152	Occupational Therapy (Day 1-28) by an OT	T2025:GO:U4	Home Health - Occupational Therapy Assist.
G0152:UD	Occupational Therapy (Day 29 and beyond) by an OT	T2025:GP	Physical Therapy-15 Mins
G0152:U8	HHCP-SERV OF OT, EA 15 Mins	T2025:GP:U4	Physical Therapy Assistant -15 Mins

UPMC HealthChoices (28242)

Diagnosis Code must be added to Patient contract.

Service Code	Description	Service Code	Description
92551	Screening Test, Pure Tone, Air Only	G0156AT	Aide in Home Health or Hospice - 15 Mins - AT
92552	Pure tone audiometry (threshold); Air Only	G0156TT	Aide in Home Health or Hospice - 15 Mins - TT
99500AT	Home Visit Prenatal (Non HBP) Assessment	G0156U8	HHA visit to patient's home (Day 1-28) by a HH Aide
99501AT	Home Visit Postnatal (Non HBP) Follow-up Care	G0156U8UD	HHA visit to patient's home (Day 29 and beyond) by a HH Aide
99501ATGT	Home Visit Postnatal (Non HBP) Follow-up Care Audio/Video	G0156U9	Aide in Home Health or Hospice - 15 Mins - U9
G0108	Diabetes Outpatient Training Service, individual	G0156UD	Aide in Home Health or Hospice - 15 Mins - UD
G0109	Diabetes Outpatient Training, group	G0299	Dir SNS RN HH/Hospice Set
G0151	Physical Therapy (Day 1-28) by a PT	G0299U8	HHA visit to a patient's home (Day 1-28) by a RN
G0151U8	HHCP-SERV OF PT, EA 15 Mins	G0299U8UD	HHA visit to patient's home (Day 29 and beyond) by a RN
G0151UD	Physical Therapy (Day 29 and beyond) by a PT	G0299UB	Dir SNS RN HH/Hospice Set - UB
G0152	Occupational Therapy (Day 1-28) by an OT	G0300	Dir SNS LPN HH/Hospice Set
G0152U8	HHCP-SERV OF OT, EA 15 Mins	G0300U8	HHA visit to a patient's home (Day 1-28) by a LPN
G0152UD	Occupational Therapy (Day 29 and beyond) by an OT	G0300U8UD	HHA visit to patient's home (Day 29 and beyond) by a LPN
G0153	Speech Therapy (Day 1-28) by a ST	G0300UB	Dir SNS LPN HH/Hospice Set - UB
G0153UD	Speech Therapy (Day 29 and beyond) by a ST	S9127	Social Work Visit, In the Home, Per Diem
G0154	HHCP - Svs of RN, EA 15 Mins	S9128	Speech Therapy, In the Home
G0155	Social Worker	S9129	Occupational Therapy, In the Home
G0156	Aide in Home Health or Hospice - 15 Mins	S9131	Physical Therapy, In the Home