DARS, or its successor agency, negotiates contracts with providers which are reimbursed in accordance with 1 TAC §355.9040.
Post-acute rehabilitation non-residential services for traumatic brain injury and traumatic spinal cord injury can be either facility based or community based. The base rate covers administrative services, paraprofessional services, and facility and operations costs. Providers will bill a standard facility ($11.21) or community ($10) base fee plus an hourly rate for the core therapy services provided to the consumer using CPT codes.
For example, a consumer receives services in a non-residential setting on Monday. The consumer receives one hour of physical therapy, one hour of occupational therapy, one hour of speech therapy, and one hour of art therapy. The provider bills for four hours of therapy, submitting a separate bill for each therapy with supporting CPT code(s) and providing supporting documentation for each i.e., therapy notes, assessments, and/or reports. The provider submits a separate bill for four hours at the base rate to cover administrative services, paraprofessional services, and facility and operations costs.
If the consumer does not receive therapy services from an approved certified or licensed professional while at the facility, the provider bills only for the time that the consumer is at the facility and bills only at the base rate. For example, the consumer attends the program for four hours, but does not receive any therapy services. The provider submits a bill for four hours at the base rate.
Bills for services must be submitted monthly. Data supporting the service must accompany each invoice. See CRS Standards for Providers, Chapter 6: General Billing Guidelines for additional billing guidelines.