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Services for children and adolescents with autism spectrum disorders: payment issues

Lynn M Wegner1, Michelle M Macias

  • 1University of North Carolina School of Medicine, Chapel Hill, USA.

Pediatric Annals
|February 14, 2009
PubMed

Insights

Primary care physicians can improve early autism identification and care coordination for children. Utilizing existing medical codes for developmental and behavioral services can overcome payment barriers for essential pediatric care.

Area of Science:

  • Pediatric Healthcare
  • Developmental Pediatrics
  • Healthcare Policy

Background:

  • Primary care physicians (PCPs) are crucial for early identification of autism spectrum disorder (ASD) in children.
  • Ensuring children with ASD have a medical home is vital for appropriate care and coordination.
  • Payment barriers can hinder PCPs from providing comprehensive developmental and behavioral health services.

Purpose of the Study:

  • To outline strategies for PCPs to optimize care for children with autism.
  • To identify methods for PCPs to navigate billing and payment for developmental and behavioral health services.
  • To promote the use of existing medical procedure codes for autism-related care.

Main Methods:

  • Review of current medical procedure codes relevant to developmental and behavioral health.
  • Analysis of practice modifications to align services with existing billing structures.
  • Discussion of care coordination strategies within primary care settings.

Main Results:

  • Existing medical procedure codes can be legitimately used for billing autism-related care.
  • Modifying practice habits can facilitate payment for essential services provided by PCPs.
  • Consistent use of appropriate codes can help mitigate financial barriers to care.

Conclusions:

  • PCPs play a key role in early autism identification and management.
  • Understanding and utilizing current medical codes is essential for PCPs to be reimbursed for developmental and behavioral care.
  • Addressing payment barriers through strategic coding can enhance access to care for children with autism.

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