Provider Reimbursements

• Evaluation using the Functional Behavioral Assessment and Analysis*
• Development of the initial BP, the EPR, and the updated BP*
• Quarterly, in-person meetings between the EIA Supervisor and the primary caregivers
• One-on-one services; Group EIA sessions are not a covered benefit
• When EIA services are rendered jointly, in-person, during EIA supervision, only the EIA supervisor time may be reimbursed

*There is a maximum of not more than four hours allowed for conducting the initial Functional Behavioral Assessment and Analysis and establishment of the initial BP.

If you are already providing ABA therapy to a beneficiary under the ECHO program, you must obtain authorization from the ECHO Case Manager before transitioning the beneficiary to the Demonstration.

      
Reassessment is conducted as part of routine supervision services and is not separately reimbursable.

Claims for Demonstration services must be submitted on a Centers for Medicare and Medicaid (CMS) 1500 using the following codes:

S5108	Home Care training to home care client, per 15 minutes
	Functional Behavioral Assessment and Analysis including initial BP EIA services rendered jointly by an EIA Supervisor and an EIA Tutor, in person, during directly supervised fieldwork of the Tutor by the Supervisor Reimbursement during Tutor supervision is limited to the higher rate as determined by the ECHO case manager.  There is no reimbursement for Tutor services using H2019 during the time in which the Supervisor is supervising and billing with code S5108.
H2019	Therapeutic behavioral services, per 15 minutes
	EIA services provided directly by an EIA Tutor
99080	Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form
	Development of the required EPR and updated BP This code is an episode of care and is not defined in minutes or units. Reimbursement is limited to the negotiated rate up to the TRICARE maximum allowable charge which is based on the zip code where the beneficiary resides.
90887	Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible person, or advising them how to assist patient.
	Conducting the required quarterly progress meetings with the TRICARE beneficiary's caregivers This code is an episode of care and is not defined in minutes or units. Reimbursement is limited to the negotiated rate up to the TRICARE maximum allowable charge which is based on the zip code where the beneficiary resides.

Billing for tutor services must be submitted by the TRICARE authorized EIA Supervisor; tutors may not bill directly for services.