NEBRASKA MEDICAID PROGRAM

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Nebraska Medicaid Program

Provider Information

Physical Therapy Provider Handbook

The links below comprise your Nebraska Medicaid Provider Handbook. This handbook is your primary resource for information about the Nebraska Medicaid Program, including program regulations, service coverage requirements and limitations, forms, billing requirements, and payment information.

Please review this handbook prior to providing services and requesting payment from Nebraska Medicaid and share it with personnel who perform referrals, authorization, coding and claims submission for your office.

If you have questions or comments about this information, contact the Medicaid Program Specialist for the type of service: Contacts Medicaid.

Regulations

Table of Contents

Chapter 1	Administration
Chapter 2	Provider Participation
Chapter 3	Payment for Medical Services
Chapter 17	Physical Therapy Services

Appendices (Forms, Reports and Instructions)

471-000-49	Claims Submission Table
471-000-50	Standard Electronic Transaction Instructions
471-000-58	Example of Form CMS-1500, “Health Insurance Claim Form” (formerly HCFA-1500)
471-000-61	Billing Instructions for Physical Therapy, Speech Pathology and Audiology Services, and Occupational Therapy
471-000-70	Nebraska Medicaid Billing Instructions for Medicare Crossover Claims
471-000-79	Form EA-160, "Record of Health Cost - Share of Cost - Medicaid Program", and Completion Instructions
471-000-85	Explanation of Remittance Advice and Refund Requests Report
471-000-87	Example of Form MC-2, "Electronic Attachment Control Number Form"
471-000-90	Form MC-19, “Medical Assistance Provider Agreement” and Completion Instructions
471-000-99	Medicaid Claim Adjustment and Refund Procedures
471-000-100	Form MCP575, "Casualty Insurance Policy Information Sheet"
471-000-121	Explanation of Form PDS-38B, "Nebraska Health Connection ID Document"
471-000-122	Nebraska Health Connection: Listing of Plans and Vendors
471-000-123	Explanation of Nebraska Medicaid Eligibility Documents
471-000-124	Instructions for Using the Nebraska Medicaid Eligibility System (NMES)
471-000-126	Procedure Codes Subject to Copayment Requirements
471-000-127	Explanation of Deleted Medicaid Claims Weekly Report (MCP564-D)
471-000-128	Explanation of Medicaid Claims in Process Over 30 Days Report (MCP564-S)
471-000-208	Form MS-79, "Wheelchairs and Wheelchair Seating System Equipment Selection Report," and Completion Instructions
471-000-517	Nebraska Medicaid Practitioner Fee Schedule for Physical Therapy and Occupational Therapy

Provider Bulletins

Number	Subject	Date
08-24	Fee Schedule Update	06/26/08
08-22	Annual Physical Therapy, Speech Therapy and Occupational Therapy Benefit Limit for Adults with Medicaid Coverage	06/30/08
08-12	DHHS Website Email Notification Feature, Online Provider Handbooks and Provider Bulletins, Electronic Claims, Funds Transfer and Other Options	05/12/08
08-04	Pregnancy - Related Services for the Ineligible Mother of an Eligible Unborn Child	02/11/08
07-10	New Medicaid Claim Reports – New Process for Reporting Deleted Medicaid Claims	05/09/07
06-20	Medicaid Coverage of Physical and Occupational Therapy	08/14/06
05-06	Medicaid Coverage of Physical and Occupational Therapy	02/15/05

Go to Rules and Regulations and Provider Bulletins for all Medicaid regulations, appendices and bulletins.

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