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Notice Regarding EPSDT Billing Requirements

2/27/26

WellCare of Kentucky is implementing changes to reimbursement codes for EPSDT therapy services currently billed under “S” codes. These changes align with updated Kentucky Medicaid and federal billing requirements and will take effect April 1, 2026 (with a 90-day grace period to allow providers time to adjust and update prior authorizations).

Summary of Changes

Effective April 1, 2026, the following codes will replace the existing EPSDT “S” codes for therapy services:

  1. Speech Therapy
    • Current Code: S9128
    • New Code: 92507 – Treatment of speech, language, voice, communication, and/or auditory processing disorder
  2. Occupational Therapy
    • Current Code: S9129
    • New Code: 97799 – Unlisted Physical Medicine/Rehabilitation Service or Procedure
  3. Physical Therapy
    • Current Code: S9131
    • New Code: 97039 – Unlisted modality

Reimbursement and Billing Requirements

  • Providers will receive one payment of $85.05 per therapy type per date of service, regardless of the number of units or codes billed.
  • All claims must include Modifier EP as the first position modifier.
  • In addition, the therapy-specific modifiers must be billed:
    • GN – Speech therapy plan of care
    • GO – Occupational therapy plan of care
    • GP – Physical therapy plan of care
  • In accordance with federal and state guidelines, prior authorization is required for all EPSDT services.
  • Documentation must specify the procedure(s) performed to support reimbursement under the unlisted code.

Action Required

Please update your billing systems and processes to reflect these changes by April 1, 2026. If additional time is needed beyond the 90-day grace period, contact our Provider Relations team for assistance.