NEW CLIENT INFORMATION

*All new client referrals must submit a Behavior Analysis services request form in order to be placed on our wait list.  Please click the link below to complete the form. 

Medicaid Required Documentation

The following is the documentation that is needed for a child to receive Behavior Analysis services through Medicaid. 

Doctor Order for Behavior Analysis

  • Referral written on prescription pad stating the client's name, DOB, ICD-10 code diagnosis, and must state "Referring for Behavior Analysis"

  • ICD-10 code diagnosis: Must be the most specific diagnosis code. (Diagnosis cannot say unspecified)

  • Signed by the referring Doctor

Comprehensive Diagnostic Evaluation (CDE)

Comprehensive Diagnostic Evaluations (CDE) are complete Biopsychosocial and Developmental Evaluations conductions by either:

  1. Board certified/board eligible Developmental Pediatrician

  2. Board certified/board eligible Child and Adolescent Psychiatrist

  3. Board certified/board eligible Pediatric neurologist

  4. Licensed clinical Child and Adolescent Physchologist


Components of the CDE should include:​

  • History of present illness (HPI) to include the details of concerning behaviors and/or skills deficits to warrant referral for BA services

  • Past Medical history including any genetic testing/anomalies, head trauma/seizure disorders, relevant co-morbid conditions

  • Past psychiatric history including mental health interventions, priory therapy interventions, medication trials, co-morbid conditions

  • Developmental history including pre/post-natal events contributing to presentation; milestone acquisition/delays

  • Vision/hearing screenings

  • Laboratory studies including genetic testing if relevant or other pertinent studies (brain imaging, EEG)

  • Psychoeducational/psychological testing or screenings such as M-CHAT-R, ADOS, Gilliam, WISC, Batelle, ASQ, Vineland Diagnostic impression

  • Recommendations for treatment from comprehensive perspective: biopsychosocial model

  • Order/referral for Behavioral Analysis if clinically indicated (date and diagnostic code on it)

**Once obtained, please submit via email:  kathleen.ganesan@potpba.com or fax: 305-290-3081

If you have any further questions while obtaining the above information please do not hesitate to contact us directly at: 

 

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Contact

Office: 772-569-5699

Fax: 305-290-3081

Address

900 27th Ave

Vero Beach, FL 32960

*All photos on the website are stock photos from the internet*

©2019 by Piece of the Puzzle Behavior Analysis.