Birth to Three State Rates
Below are the state rates for Birth to Three Early Intervention (EI) services as of 10/1/17
Evaluation: $180 per unit where one unit equals one person completing an evaluation regardless of the time required – max 2 units per day and 4 units per calendar year without prior authorization (PA) from the OEC. (Procedure Code T1023)
Assessment: $120 per hour billable in 15 minute units – max 8 units per calendar year. (Procedure Code T1028)
IFSP meetings: $120 per hour billable in 15 minute units – max 40 units per calendar year. (Procedure Code T2024)
NOTE: All PA requests must be emailed to CTBirth23@ct.gov.
EI Treatment Service (EITS) – max 32 units per day no PA permitted
Professional Rates: $120 per hour if only six 15 minute units are billed per practitioner per day. (Procedure Code H2014)
If more than six units are billed per practitioner per day all the units in the day a paid using $96 per hour. (Procedure Code H2014 TF)
Para professional Rates: $84 per hour if only six 15 minute units are billed per practitioner per day. (Procedure Code T1027)
If more than six units are provided per practitioner per day all the units in the day a paid using $48 per hour. (Procedure Code T1027 TF)
General Administrative Payment: $100 per child for the program with an IFSP on the 1st of the billing month that plans for less than 9 hours of service per month and as long as at least one service was provided during the billing month. GAPs for children that transfer programs are paid to the program with the IFSP on the 1st of the month as long as a service was provided by the sending program before the transfer. Receiving programs will be paid the GAP in the following month.
NOTE: Beginning with Dates of Service July 1, 2017 the Birth to Three System contracted with Public Consulting Group to submit claims for Early Intervention Services to commercial insurance. Birth to Three System does not require the use of the codes or modifiers listed on the DSS Medicaid fee schedule for commercial claims. In addition, the Birth to Three System does not require the use of specific CPT, HCPCS codes or modifiers for commercial claims. The Birth to Three System recognizes the contractor’s use industry standard modifier to identify the Birth to Three claims. Currently the TL “Early Intervention/individualized family service plan (IFSP)” is placed on all early intervention claims by PCG and submitted in an 837 EDI transaction. Birth to Three also requests that the Contractor use the Level I (CPT) and Level II (HCPCS) code sets which best reflect the services provided by the Early Intervention professional.