Local Educational Agency (LEA) Medi-Cal Billing Option Program rates are announced for state fiscal year 2021 thru 2022 and telehealth services are rolled out for most LEA practitioners, as follows.
Reimbursement Rates for LEA Services: Fiscal Year 2021 Thru 2022
Effective for dates of service on or after July 1, 2021, the “LEA Services Billing Codes Chart” in the Part 2, Local Educational Agency (LEA) Billing Codes section is updated with the most recent LEA reimbursement rates for state fiscal year 2021 thru 2022.
Telehealth Available for Most Providers and Most LEA Services
Also effective for dates of service on or after July 1, 2021, telehealth services rendered by LEA practitioners for all LEA services require modifier 95 (telehealth) for reimbursement. The following services are not eligible to be billed via telehealth and claims submitted with modifier 95 will be denied for dates of service on or after July 1, 2021:
- School health aide services (HCPCS code T1004)
- Assistance with activities of daily living (CPT® code 97535)
- Medical transportation (HCPCS code T2003)
- Mileage (HCPCS code A0425)
Practitioners may refer to the “LEA Services Billing Codes Chart” in the Part 2, Local Educational Agency (LEA) Billing Codes and Reimbursement Rates provider manual section to find services that are reimbursable when rendered via telehealth. The first column of the chart will indicate “Add modifier 95 if via telehealth.”
Allowable treatment services must be documented in the student’s Individualized Education Plan (IEP), Individualized Family Services Plan (IFSP) or Individualized Health and Support Plan (IHSP). However, it is not required that the service modality (for example, whether the service is delivered via telehealth or face-to-face) be documented in the IEP, IFSP or IHSP. All utilization controls that apply to standard LEA services also apply to LEA telehealth services.
Telehealth Services Rendered During the COVID-19 Public Health Emergency (PHE)
LEA policy for telehealth services rendered during the PHE remains effective until the PHE is terminated. For more information, practitioners may refer to Policy and Procedure Letter #20-014R, titled Local Educational Agency Medi-Cal Billing Option Program (LEA BOP) Telehealth Policy Relative to the Coronavirus Disease 2019 (COVID-19).
