Wis. ForwardHealth Online Handbook, Hospice, Topic #22917

ForwardHealth reimburses interpretive services provided to BadgerCare Plus and Medicaid members who are deaf or hard of

hearing or who have LEP (limited English proficiency). A member with LEP is someone who does not speak English as their

primary language and who has a limited ability to read, speak, write, or understand English.

Interpretive services are defined as the provision of spoken or signed language communication by an interpreter to convey a

message from the language of the original speaker into the language of the listener in real time (synchronous) with the member

present. This task requires the language interpreter to reflect both the tone and the meaning of the message.

Only services provided by interpreters of the spoken word or sign language will be covered with the HCPCS (Healthcare

Common Procedure Coding System) procedure code T1013 (Sign language or oral interpretive services, per 15 minutes).

Translation services for written language are not reimbursable with T1013, including services provided by professionals trained to

interpret written text.

Covered Interpretive Services

ForwardHealth covers interpretive services for deaf or hard of hearing members or members with LEP when the interpretive

service and the medical service are provided to the member on the same DOS (date of service) and during the same time as the

medical service. A Medicaid-enrolled provider must submit for interpretive services on the same claim as the medical service, and

the DOS they are provided to the member must match. Interpretive services cannot be billed by HMOs and MCOs (managed

care organizations). Providers should follow CPT (Current Procedural Terminology) and HCPCS coding guidance to

appropriately document and report procedure codes related to interpretive and medical services on the applicable claim form.

Time billed for interpretive services should reflect time spent providing interpretation to the member. At least three people must be

present for the services to be covered: the provider, the member, and the interpreter.

Interpreters may provide services either in-person or via telehealth. Services provided via telehealth must be functionally

equivalent to an in-person visit, meaning that the transmission of information must be of sufficient quality as to be the same level of

service as an in-person visit. Transmission of voices, images, data, or video must be clear and understandable. Both the distant

and originating sites must have the requisite equipment and staffing necessary to provide the telehealth service.

Billing time for documentation of interpretive services will be considered part of the service performed. BadgerCare Plus and

Wisconsin Medicaid have adopted the federal "Documentation Guidelines for Evaluation and Management Services" (CMS

(Centers for Medicare & Medicaid Services) 2021 and 2023) in combination with BadgerCare Plus and Medicaid policy for

E&M (evaluation and management) Services.

Most Medicaid-enrolled providers, including border-status or out-of-state providers, are able to submit claims for interpretive

services.

Standard ForwardHealth policy applies to the reimbursement for interpretive services for out-of-state providers, including PA

(prior authorization) requirements.

Interpretive Services Provided Via Telehealth for Out-of-State Providers

ForwardHealth requirements for services provided via telehealth by out-of-state providers are the same as the ForwardHealth

policy for services provided in-person by out-of-state providers. Requirements for out-of-state providers for interpretive services

are the same whether the service is provided via telehealth or in-person. Out-of-state providers who are not enrolled as either

border-status or telehealth-only border-status providers are required to obtain PA before providing services via telehealth to

BadgerCare Plus or Medicaid members. The PA would indicate that interpretive services are needed.

Documentation

While not required for submitting a claim for interpretive services, providers must include the following information in the member's

file:

• The interpreter's name and/or company

• The date and time of interpretation

• The duration of the interpretive service (time in and time out or total duration)

• The amount submitted by the medical provider for interpretive services reimbursement

• The type of interpretive service provided (foreign language or sign language)

• The type of covered service(s) the provider is billing for

Third-Party Vendors and In-House Interpreters

Providers may be reimbursed for the use of third-party vendors or in-house interpreters supplying interpretive services.

Providers are reminded that HIPAA (Health Insurance Portability and Accountability Act of 1996) confidentiality requirements

apply to interpretive services. When a covered entity or provider utilizes interpretive services that involve PHI (protected health

information), the entity or provider will need to conduct an accurate and thorough assessment of the potential risks and

vulnerabilities to PHI confidentiality, integrity, and availability. Each entity or provider must assess what are reasonable and

appropriate measures for their situation.

Limitations

There are no limitations for how often members may utilize interpretive services when the interpretive service is tied to another

billable medical service for the member for the same DOS.

Claims Submission

To receive reimbursement, providers may bill for interpretive services on one of the following claim forms:

• 1500 Health Insurance Claim Form ((02/12)) (for dental, professional, and professional crossover claims)

• Institutional UB-04 (CMS 1450) claim form (for outpatient crossover claims and home health/personal care claims)

Noncovered Services

The following will not be eligible for reimbursement with procedure code T1013:

• Interpretive services provided in conjunction with a noncovered, non-reimbursable, or excluded service

• Interpretive services provided by the member's family member, such as a parent, spouse, sibling, or child

• The interpreter's waiting time and transportation costs, including travel time and mileage reimbursement, for interpreters to

get to or from appointments

• The technology and equipment needed to conduct interpretive services

• Interpretive services provided directly by the HMOs and MCOs are not billable to ForwardHealth for reimbursement via

procedure code T1013

Cancellations or No Shows

Providers cannot submit a claim for interpretive services if an appointment is cancelled, the member or the interpreter is a no-show

(is not present), or the interpreter is unable to perform the interpretation needed to complete the appointment successfully.

Procedure Code and Modifiers

Providers must submit claims for interpretive services and the medical service provided to the member on separate details on the

same claim.

Procedure code T1013 is a time-based code, with 15-minute increments. Rounding up to the 15-minute mark is allowable if at

least eight minutes of interpretation were provided.

Providers should use the following rounding guidelines for procedure code T1013.

Claims for interpretive services must include HCPCS procedure code T1013 and the appropriate modifier(s):

• U1 (Spoken language)

• U3 (Sign Language)

• GT (Via interactive audio and video telecommunication systems)

• 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications

system)

Providers should refer to the interactive maximum allowable fee schedules for the reimbursement rate, covered provider types and

specialties, modifiers, and the allowable POS (place of service) codes for procedure code T1013.

Time (Minutes) Number of Interpretation Units Billed

8–22 minutes 1.0 unit

23–37 minutes 2.0 units

38–52 minutes 3.0 units

53–67 minutes 4.0 units

68–82 minutes 5.0 units

83–97 minutes 6.0 units

*Any telehealth service must be provided using HIPAA-compliant software or delivered via an app or service that includes all the

necessary privacy and security safeguards to meet the requirements of HIPAA.

Dental Providers

Dental providers submitting claims for interpretive services are not required to include a modifier with procedure code T1013.

Dental providers should retain documentation of the interpretive service in the member's records.

Allowable Places of Service

Claims for interpretive services must include a valid POS (place of service) code where the interpretive services are being

provided.

Federally Qualified Health Centers

Non-Tribal FQHCs (federally qualified health centers), also known as CHCs (community health centers), and Tribal FQHCs

(POS codes 50 and XX), will not receive direct reimbursement for interpretive services as these are indirect services assumed to

be already included in the bundled PPS (prospective payment system) (or AIR (all-inclusive rate) for Tribal FQHCs) rate.

However, CHCs and Tribal FQHCs can still bill the T1013 code as an indirect procedure code when providing interpretive

services. This billing process is similar to that of other indirect services provided by non-Tribal FQHCs. This will enable

Wisconsin DHS (Department of Health Services) to better track how CHCs and Tribal FQHCs provide these services and

process any future change in scope adjustment to increase their PPS rate that includes providing interpretive services.

Rural Health Clinics

RHCs (rural health clinics) (POS code 72) receives direct reimbursement for interpretive services. Procedure code T1013 should

be billed when providing interpretive services.

Delivery Method of

Interpretive Services Definition for Sign Language and Foreign Language Interpreters Modifiers

In person

(foreign language and sign

language)

When the interpreter is physically present with the member and provider

U1 or U3

Telehealth*

(foreign language and sign

language)

When the member is located at an originating site and the interpreter is available

remotely (via audio-visual or audio only) at a distant site

U1 or U3 and

GT or 93

Phone

(foreign

language only)

When the interpreter is not physically present with the member

and the provider and interprets via audio-only through the

phone

U1 and 93

Interactive

video

(foreign

language and

sign language)

When the interpreter is not physically present with the member

and the provider and interprets on interactive video

U1 or U3 and

GT

Interpreter Qualifications

The two types of allowable interpreters include:

• Sign language interpreters— Professionals who facilitate the communication between a hearing individual and a person who

is deaf or hard of hearing and uses sign language to communicate

• Foreign language interpreters— Professionals who are fluent in both English and another language and listen to a

communication in one language and convert it to another language while retaining the same meaning

Qualifications for Sign Language Interpreters

For Medicaid-enrolled providers to receive reimbursement, sign language interpreters must be licensed in Wisconsin under Wis.

Stat. § 440.032 and must follow the specific requirements regarding education, training, and locations where they are able to

interpret. The billing provider is responsible for determining the sign language interpreter's licensure and must retain all

documentation supporting it.

Qualifications for Foreign Language Interpreters

There is not a licensing process in Wisconsin for foreign language interpreters. However, Wisconsin Medicaid strongly

recommends that providers work through professional agencies that can verify the qualifications and skills of their foreign language

interpreters.

A competent foreign language interpreter should:

• Be at least 18 years of age.

• Be able to interpret effectively, accurately, and impartially, both receptively and expressively, using necessary specialized

vocabulary.

• Demonstrate proficiency in English and another language and have knowledge of the relevant specialized terms and

concepts in both languages.

• Be guided by the standards developed by the National Council on Interpreting Health Care.

• Demonstrate cultural responsiveness regarding the LEP language group being served including values, beliefs, practices,

languages, and terminology.