Planning for Autism Procedure Code Changes

Planning for Autism Procedure Code Changes

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The Department of Human Services (DHS), in collaboration with the Insurance Department, will be implementing updated physical health and behavioral health autism spectrum disorder (ASD) related procedure and diagnosis codes as a key element of the state’s Medicaid (MA) cost avoidance initiative, effective September 30. These changes will reflect a more complete and updated array of ASD related procedure and diagnostic codes that will be recognized by commercial insurance plans as well as MA. The goal of these changes is to identify the service array that is covered by commercial health insurance plans, reduce the financial burden on the MA system, and to improve the uniformity of coding and billing for services. The September 30 implementation date will allow additional time for the state, in collaboration with RCPA, to provide outreach and training to providers of services for children with an ASD. As a member of the state’s Act 62 External Work Group, RCPA will be meeting with DHS to develop materials and plan for informational webinars to prepare providers for these changes. RCPA will provide information and updates as they become available.

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