MedicaidBilling CodesHigh impact
Provider News - February 2017
Security Health Plan·WI · Physical Therapy, Occupational Therapy, Speech Therapy·Provider News
Effective date
Feb 1, 2017
We identified it
Jul 15, 2026
Summary
Security Health Plan requires decimal billing on time-based therapy codes (PT, OT, speech therapy) for BadgerCare Plus members when less than one full unit of service is provided. For example, 7.5 minutes of a 15-minute code should be billed as 0.5 units. The plan will audit therapy claims for accurate compliance with this requirement.
Action Required
Immediately: Billing team must update all therapy billing workflows to implement decimal billing for time-based codes when billing BadgerCare Plus members. (1) Train all staff on decimal calculation methodology (divide actual minutes provided by the unit time specified in the code). (2) Update billing software to require decimal entry fields for PT, OT, and speech therapy codes with time-based units. (3) Update encounter forms/templates to include decimal billing instructions for providers. (4) Implement pre-billing validation rules to catch whole-unit claims when partial units are documented. (5) Review current denied claims from Security Health Plan for incorrect whole-unit billing and resubmit with decimals. Failure to implement decimal billing will result in claim denials during Security Health Plan's audit of BadgerCare Plus therapy claims.