Newly Approved Codes from Ohio Department of Medicaid: Advocacy at Work

Last year, concerned members of OOTA determined that CPT Code 96125 (Standardized Cognitive Performance Testing) was not a covered service for occupational therapy under Ohio Medicaid, despite being covered under Medicare, Ohio Bureau of Worker's Compensation, and many private insurance companies. OOTA worked to advocate for coverage of this code as well as 96127 (Brief Behavioral Assessment) to both be "turned on" under Medicaid so that occupational therapy practitioners could utilize, bill, and be reimbursed for these codes under Medicaid as they are under other payers.

In late February 2022,  we finally received good news from our efforts with the following message from Medicaid:

• 96125 and 96127 are covered by Ohio Medicaid in hospital settings. 96127 is also covered by Ohio Medicaid on the fee schedule and it is allowed for practitioners of physician services and behavioral health providers.  Going forward, ODM will add this code to the skilled therapy contract for skilled therapists.
• 96125 which is an assessment performed by a health care professional is not currently listed on the ODM professional fee schedule. Going forward, ODM will also add 96125 to the skilled therapy contract which will allow skilled therapists to bill for this service.

We hope to have these codes ready and available for use through Medicaid by the time the new managed care systems go online on July 1st. For further questions about this issue, you may contact OOTA lobbyist Danny Hurley.