12VAC30-80-97: Fee-for-service: behavioral therapy services under EPSDT

A. Payment for behavioral therapy services for individuals younger than 21 years of age shall be the lower of the state agency fee schedule or actual charge (charge to the general public). All private and governmental fee-for-service providers shall be reimbursed according to the same methodology. The agency's rates were set as of October 1, 2011, and are effective for services on or after that date until rates are revised. Rates are published on the agency's website at www.dmas.virginia.gov.

B. Providers shall be required to refund payments made by Medicaid if they fail to maintain adequate documentation to support billed activities.