Mass Adjustment of the 2020 Behavioral Health and Substance Abuse Fee Schedule
(Feb. 3, 2021) Because the 2020 Behavioral Health and Substance Abuse Fee Schedule was not implemented until Nov. 13, 2020, DMS must mass adjust claims back to the Jan. 1, 2020 effective date. Providers may see adjustments negatively or positively impact claims reimbursement for services from Jan. 1, 2020 to Nov. 13, 2020. Providers should see adjustments on the cycle dated Feb. 12.
DME Updated Notice - Due to the ongoing COVID-19 public health emergency, Medicaid has suspended the 2020 DME fee schedule changes due to become effective Nov. 15, 2020. However, Medicaid will update the DME fee schedule in compliance with the required upper payment limit demonstration and publish a new fee schedule effective Jan. 1, 2021.
Each year Kentucky Medicaid is required to provide an upper payment limit demonstration for CMS on all DME codes covered by Medicaid. The demonstration must show rates are the same as or less than Medicare rates. CMS notified Medicaid that it had not provided the upper payment limit demonstration for 2020. A rate change adjustment was applied, first retroactive until Jan. 1, 2020, which triggered recoupments. Medicaid reprocessed and repaid any recouped claims and posted a notice that the fee schedule changes would take effect on Nov. 15, 2020. At this time no changes will be made to the 2020 DMS fee schedule. Medicaid apologizes for the inconvenience and confusion caused by these decisions.
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Disclaimer: The appearance on this website of a code and rate is not an indication of coverage or a guarantee of payment.
To request older copies of fee schedules, please submit an open records request by mail or fax directly with the open records custodian at the address is below.
Open Records Custodian
Dept. for Medicaid Services
275 East Main Street, 6W-C
Frankfort, Kentucky 40601
(502) 564-8196 x2035 (P)
(502) 564-6917 (Fax)