Pennsylvania Autism Insurance Act (Act 62)

For Providers

DHS has identified procedure codes that reflect services for the diagnostic assessment and treatment of Autism Spectrum Disorder (ASD) and may be subject to Act 62. Providers should confirm with the Medicaid beneficiary's private health insurance which procedure codes are on their fee schedule, and check with the Medicaid fee schedule or contact the appropriate managed care organization to determine which procedure codes are on their fees schedules. DHS will continue to review procedure codes to identify additional codes that reflect services for the diagnostic assessment and treatment of ASD.

• Procedure Codes for Act 62 Covered Services
  
• Act 62 ICD-10-CM Diagnosis Codes
  

On August 25, 2016, DHS and the Pennsylvania Insurance Department presented a webinar on changes impacting providers of child and adolescent autism services, as well as HealthChoices managed care organizations. The webinar included:

• Guidance for providers enrolled in the Medicaid Program, both fee-for-service and HealthChoices, about the requirement to bill a child's or adolescent's private health insurance company before submitting a claim for the diagnostic assessment or treatment of ASD.
  
• Clarification about the use of behavioral health, physical health, and rehabilitation procedure codes that reflect services for the diagnostic assessment and treatment of ASD covered under Act 62
• A review of updated information and guidance for families that providers can duplicate and make available to families of children and adolescents with ASD

The recording of the webinar is available for review. The Power Point presentations for both the managed care and the service provider presentations are also now available.