Is speech pathology reimbursed by United Healthcare Medicaid: MMA in Florida?

Speech pathology services are covered by UHC Medicaid or United Healthcare Medicaid also known as an MMA plan. Our clinic in Gainesville, Florida Wildflower Therapy has completed many failed attempts to be paid by UHC Medicaid over the years and we are now experts in reimbursements for this plan. As a provider there are rules for each step of your referral. Do not schedule your patient without the primary care office requesting authorization for evaluation only codes on the uhcprovider.com

How to be paid by UHC Medicaid for an Evaluation: Request the PCP office to do the following steps:

1. Login to the uhcprovider.com

2. Input a referral from their provider (individual NPI to your provider individual NPI). Each provider must also be a medicaid provider with the state of Florida. 

3. Provider the PCP office with the correct CPT codes. 

For speech pathology it is easiest to request 1 visit at 92523 (speech, language, evaluation) and if your clinic completes dysphagia evaluation and intervention 1 visit at 92610. 

4. The PCP office will then obtain an A# from UHC. 

5. Request the PCP to fax you the A# from uhcprovider. 

6. Authorization: Now you can schedule the patient for evaluation only. 

7. Complete your evaluation with findings. They must include attempts for formal assessment or an actual formal assessment from the SLP. If you could not complete a formal assessment you must indicate why and what you tried to do. Each evaluation is reviewed by UHC clinician. 

8. For billing:  For the initial visit in CMS 1500 box 23 input the A# of if you have system that does this for you from your electronic medical record input the authorization at 1 visit with both CPT codes. 

8. For Audits: Fax your POC and evaluation to the physician. Get it signed and have it on file in clinic. 

9. For future treatment visits: Upload your evaluation with formal assessment to myoptumphysicalhealth.com with the filled out questionnaire and original PCP referral along with requested treatment visits. Within 48-72 hours you will receive an email of authorization approved or partial approval with a new number for authorized treatments. If you have an EMR input this into your EMR with date range, number of visits and authorization number. 

7. Schedule for treatment. UHC MMA (Medicaid) approves the child in number of visits over a period of time for treatment. So for example they may say 32 visits with a start date of 5/5/2023-11/5/2023. The length of time you see are reimbursed and able to see the child is up to 4 units per day. So you can decide you want this child to come 1x week at 60 minutes or 2x week at 30 minutes. 

Other things to note. UHC medicaid likes to do things where you request a 6 month POC and they modify to 13 weeks approval. Around week 11 you will want to complete a reassessment to request additional therapy if indicated. And repeat the 

Things we have learned:

1. Use a template with a letterhead faxed to the physician. 

2.  Send the same template via your secure portal to the patient so that they too can request from PCP. 

3. Our patients can get things easier and faster than our staff from their PCP. 

4. Do NOT schedule without this number, you will not be reimbursed or backdated. 

5. Document who you speak to at the PCP and make friends and relationships with them so that each time you can speak to the same person. 

6. Would you like to purchase our template in word document and input your own logo! Visit our product page and link below. 

https://wildflower-therapy.mykajabi.com/products/2148260318/preview?preview_theme_id=2154264141

 Helpful Pointers:

UHC Medicaid will deny F80.9 diagnosis: Unspecified Speech Disturbance.
Speak with your physicians medical team to consider F80.2 or F80.0.

Reimbursement Rates follow the Florida Fee Schedule posted on ACHA

http://ahca.myflorida.com/content/download/20104/file/Speech_Language_Pathology_Services_Fee_Schedule_2022_JULY.pdf

92523 is $51.05 and 92610 is $44.55

Lauren Meffen 

MA/CCC/SLP, CLT

Speech Language Pathologist & Certified Lymphedema Therapist SA#9770