Independent Overtime Rates

Original Implementation of Overtime Rates 1/1/2016
New Requirement for Splitting Visits Effective 4/1/2016


Effective January 1st the Ohio Medicaid program will make overtime payments to Independent Providers for any hours worked over 40 in a workweek.

  • Independent Providers who bill their services to ODM, ODA, & DODD will now receive overtime rates when billing more than 40 hours or 160 fifteen-minute units in a week.
  • A workweek is defined as beginning Sunday at 12:00 AM and ending Saturday at 11:59 PM.
  • The overtime rates are only for dates of service beginning on or after January 1st.
  • Personal Care Aides (T1019), Home Care Attendant (S5125), and Waiver Nursing (T1002, T1003) under the Ohio Home Care Waiver, Transitions DD waiver and PDN (T1000) services must use the “TU” modifier when billing for a full shift of overtime hours.
    • When you are billing a visit that is part regular hours and part overtime hours you will split the shift on to two claim service lines and use the “UA” modifier on the overtime hours.
  • Claims submitted to a managed care plan for services provided to an individual enrolled in a managed care plan are NOT included in the overtime calculation.
  • If you are billing for T1000 the TD or TE modifier will begin to be used in conjunction with the overtime modifiers beginning 4/1
    • T1000 1/1/16-3/31/16 DO NOT use TD or TE with an overtime modifier (TU or UA)
    • T1000 4/1/16 and after DO use TD or TE with overtime modifiers

Example Schedule & Claim

Schedule T1019 Aide claim T1000 LPN Claim
Sunday 3/27/16 9:00a - 1:30p
2:00p-10:00p
4.5 hours (18 units)
8 hours (32 units)
U2 4.5 hours (18 units)
8 hours (32 units)
TE
U2 TE
Monday 3/28/16 2:00p - 10:00p 8 hours (32 units) 8 hours (32 units) TE
Tuesday 3/29/16 9:00a - 1:30p
4:00p - 10:00p
4.5 hours (18 units)
6 hours (24 units)
U2 4.5 hours (18 units)
6 hours (24 units)
TE
U2 TE
Thursday 3/31/16 9:00a - 1:30p
4:00p - 10:00p
4.5 hours (18 units)
4.5 hours (18 units)
1.5 hours (6 units)
U2
U2 UA
4.5 hours (18 units)
4.5 hours (18 units)
1.5 hours (6 units)
TE
U2 TE
U2 UA
4.5 hours into this shift Overtime begins.
Split into 2 service lines on your claim.
Friday 4/1/16 2:00p - 10:00p 8 hours (32 units) TU 8 hours (32 units) TE TU

Overtime Rates will be calculated as follows:

Procedure Code Base Rate 15-minute unit Rate (Hourly Rate)
T1019 Personal Care Aide $22.46 $3.95 $15.80
S5125 Home Care Attendant Services (Nursing) $33.09 $6.22 $24.88
S5125 Home Care Attendant Services (Aide) -- $3.95 $15.80
T1003 LPN Waiver $40.89 $7.88 $31.52
T1000 Private Duty - LPN $40.89 $7.88 $31.52
T1002 RN Waiver $50.43 $9.92 $39.68
T1000 Private Duty - RN $50.43 $9.92 $39.68


For more information see http://medicaid.ohio.gov/Portals/0/Providers/ODM-IP-Update.pdf


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