On behalf of the New Mexico Council on Asthma, thank you for completing this brief survey about billing for asthma services.

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Cory Lewis
5 years ago
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1 On behalf of the New Mexico Council on Asthma, thank you for completing this brief survey about billing for asthma services. We will be asking questions about services your organization covers under Medicaid/Centennial Care, Medicare, and under commercial or health insurance exchange programs. You will be asked the same questions about each. However, you will only be asked questions about the programs you offer (for example, if you respond "no" when asked if you have a Medicare program, you won't be asked questions about Medicare coverage and reimbursement). Thank you for your time---it is very much appreciated! * 1. Which Health Plan are you representing? 2. Please provide the name, address, and phone number of the person completing the survey Name: Address: Phone Number: * 3. Do you offer services through Medicaid/Centennial Care? Medicaid/Centennial Care Page 1 1

2 * 4. Which CPT code(s) does your plan use to bill for asthma education? 98960, 98961, "patient self-management education by non-physician" S9441 Individual S9446 non-physician provider with 25 modifier with 25 modifier 5. Which of the following topics does your plan expect to be covered in their standard asthma education? Asthma Basics: Differences between a normal airway and one with asthma Understanding Medications: Difference between quick relief and controller meds Patient Skills: Demonstration of proper medication technique Patient Skills: Understanding of environmental triggers and how to avoid them Patient Skills: Self-monitoring of asthma symptoms and seeking appropriate care Patient Skills: Using an Asthma Action Plan (AAP) t Sure 6. How many asthma education sessions does your plan reimburse per patient each year (annually)? Medicaid/Centennial Care Page 2 2

3 7. Does your plan provider reimbursement for in-home asthma-related visits? (for the general patient population) Medicaid/Centennial Care Page 3 (In-Home Visits) 8. How many in-home asthma visits does your plan cover per patient per year (annually)? 9. Is a referral from the primary care provider (PCP) required for in-home visits? 10. Does your health plan provide reimbursement for in-home asthma visits if the patient is home bound? Medicaid/Centennial Care Page 4 (In-Home Visits) 3

4 11. How many visits per home-bound patient per year (annually)? 12. Is a referral required from the primary care provider (PCP) for in-home visits to homebound patients with asthma? Medicaid/Centennial Care Page 5 (Wellness Visits) 13. How many Wellness visits for asthma patients does your plan allow reimbursement for each year? Three Four or more 14. How many Wellness visits require a co-pay from the patient? All visits All visits but the first All visits after the first 2 visits Medicaid/Centennial Care Page 6 (Inhalers & Spacers) 4

5 15. Does your plan allow reimbursement for obtaining 2 Metered Dose Inhalers or MDIs (1 for school and 1 for home) at the same time? 16. How often does your plan cover patients receiving inhalers? Every 6 months Once a year (annually) As needed 17. Does your plan allow reimbursement for obtaining 2 spacers (1 for school and 1 for home) at the same time? 18. How often does your plan cover patients receiving spacers? Every 6 months Once a year (annually) As needed 19. Which of the following brands of spacers does your plan reimburse for? ACE Aerochamber E-Z Spacer Medispacer Optihaler OptiChamber Easivent 5

6 20. How does your plan reimburse for spacers? Through Pharmacy As Durable Medical Equipment (DME) Both through Pharmacy and as DME 21. How does your plan reimburse for Peak Flow Meters? Through Pharmacy As Durable Medical Equipment (DME) Both through Pharmacy and as DME The plan does not reimburse for Peak Flow Meters That was the final question about Medicaid/Centennial Care. Thank you! Medicare * 22. Do you offer services through Medicare? Medicare Page 1 6

7 * 23. Which CPT code(s) does your plan use to bill for asthma education? 98960, 98961,98962 "patient self-management education by non-physician" S9441 Individual S9446 non-physician provider with 25 modifier with 25 modifier 24. Which of the following topics does your plan expect to be covered in their standard asthma education? Asthma Basics: Differences between a normal airway and one with asthma Understanding Medications: Difference between quick relief and controller meds Patient Skills: Demonstration of proper medication technique Patient Skills: Understanding of environmental triggers and how to avoid them Patient Skills: Self-monitoring of asthma symptoms and seeking appropriate care Patient Skills: Using an Asthma Action Plan (AAP) t Sure 25. How many asthma education sessions does your plan reimburse per patient each year (annually)? Medicare Page 2 7

8 26. Does your plan provider reimbursement for in-home asthma-related visits? (for the general patient population) Medicare Page 3 (In-Home Visits) 27. How many in-home asthma visits does your plan cover per patient per year (annually)? 28. Is a referral from the primary care provider (PCP) required for in-home visits? 29. Does your health plan provide reimbursement for in-home asthma visits if the patient is home bound? Medicare Page 4 (In-Home Visits) 8

9 30. How many visits per home-bound patient per year (annually)? 31. Is a referral required from the primary care provider (PCP) for in-home visits to homebound patients with asthma? Medicare Page 5 (Wellness Visits) 32. How many Wellness visits for asthma patients does your plan allow reimbursement for each year? Three Four or more 33. How many Wellness visits require a co-pay from the patient? All visits All visits but the first All visits after the first 2 visits Medicare Page 6 (Inhalers & Spacers) 9

10 34. Does your plan allow reimbursement for obtaining 2 Metered Dose Inhalers or MDIs (1 for school and 1 for home) at the same time? 35. How often does your plan cover patients receiving inhalers? Every 6 months Once a year (annually) As needed 36. Does your plan allow reimbursement for obtaining 2 spacers (1 for school and 1 for home) at the same time? 37. How often does your plan cover patients receiving spacers? Every 6 months Once a year (annually) As needed 38. Which of the following brands of spacers does your plan reimburse for? ACE Aerochamber E-Z Spacer Medispacer Optihaler OptiChamber Easivent 10

11 39. How does your plan reimburse for spacers? Through Pharmacy As Durable Medical Equipment (DME) Both through Pharmacy and as DME 40. How does your plan reimburse for Peak Flow Meters? Through Pharmacy As Durable Medical Equipment (DME) Both through Pharmacy and as DME The plan does not reimburse for Peak Flow Meters That was the last question about Medicare. Thank you! Commercial/Exchange * 41. Do you offer services through commercial health insurance or through the health insurance exchange? Commercial/Exchange Page 1 11

12 * 42. Which CPT code(s) does your plan use to bill for asthma education? 98960, 98961, "patient self-management education by non-physician" S9441 Individual S9446 non-physician provider with 25 modifier with 25 modifier 43. Which of the following topics does your plan expect to be covered in their standard asthma education? Asthma Basics: Differences between a normal airway and one with asthma Understanding Medications: Difference between quick relief and controller meds Patient Skills: Demonstration of proper medication technique Patient Skills: Understanding of environmental triggers and how to avoid them Patient Skills: Self-monitoring of asthma symptoms and seeking appropriate care Patient Skills: Using an Asthma Action Plan (AAP) t Sure 44. How many asthma education sessions does your plan reimburse per patient each year (annually)? Commercial/Exchange Page 2 12

13 45. Does your plan provider reimbursement for in-home asthma-related visits? (for the general patient population) Commercial/Exchange Page 3 (In-Home Visits) 46. How many in-home asthma visits does your plan cover per patient per year (annually)? 47. Is a referral from the primary care provider (PCP) required for in-home visits? 48. Does your health plan provide reimbursement for in-home asthma visits if the patient is home bound? Commercial/Exchange Page 4 (In-Home Visits) 13

14 49. How many visits per home-bound patient per year (annually)? 50. Is a referral required from the primary care provider (PCP) for in-home visits to homebound patients with asthma? Commercial/Exchange Page 5 (Wellness Visits) 51. How many Wellness visits for asthma patients does your plan allow reimbursement for each year? Three Four or more 52. How many Wellness visits require a co-pay from the patient? All visits All visits but the first All visits after the first 2 visits Commercial/Exchange Page 6 (Inhalers & Spacers) 14

15 53. Does your plan allow reimbursement for obtaining 2 Metered Dose Inhalers or MDIs (1 for school and 1 for home) at the same time? 54. How often does your plan cover patients receiving inhalers? Every 6 months Once a year (annually) As needed 55. Does your plan allow reimbursement for obtaining 2 spacers (1 for school and 1 for home) at the same time? 56. How often does your plan cover patients receiving spacers? Every 6 months Once a year (annually) As needed 57. Which of the following brands of spacers does your plan reimburse for? ACE Aerochamber E-Z Spacer Medispacer Optihaler OptiChamber Easivent 15

16 58. How does your plan reimburse for spacers? Through Pharmacy As Durable Medical Equipment (DME) Both through Pharmacy and as DME 59. How does your plan reimburse for Peak Flow Meters? Through Pharmacy As Durable Medical Equipment (DME) Both through Pharmacy and as DME The plan does not reimburse for Peak Flow Meters 60. Within your organization, who would be available to answer any follow up questions? Name: Position: Phone Number: Thank you for your time and effort. If you have questions about this survey, please contact Kathy Moseley or If you have questions about the New Mexico Council on Asthma, please visit our website at and feel free to contact any NMCOA representative. 16

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