Interpreter Services and Medicaid Reimbursement

We aim to ensure that patients with Limited English Proficiency (LEP) can access healthcare services effectively. As a participating provider, you may be obligated to assist members with LEP.

This article outlines the responsibilities of providers and the billing codes, reimbursement rates, and claim submission processes for interpreter services for patients with RI Medicaid (including BlueRI for Duals).

For Medicare and Medicaid recipients (including BlueRI for Duals): Per federal regulations at 45 CFR 92.8(b)(1), Medicare and Medicaid providers are required to provide access to interpreter services, free of charge, to patients with LEP. Providers can file a claim for reimbursement of interpreter services for patients with RI Medicaid (including BlueRI for Duals).

Translation and Interpretation Agencies

Licensed Interpreters for the Deaf

RI Medicaid Reimbursement Guidelines

• Provider Contracts: Eligible providers are responsible for developing a business relationship with one or more agencies that can provide trained, competent interpreters in the needed language(s). The provider may submit a claim to RI Medicaid’s vendor, Gainwell Technologies, that documents the member name and MID number, and date of office visit. Location, type of interpretation provided, name of interpreter, agency, and agency invoice should be documented in the client’s records.
• Eligible RI Providers: Dentists, physicians, podiatrists, optometrists, nurse practitioners, outpatient hospital clinics, and behavioral health providers can seek reimbursement from RI Medicaid for interpreter services provided during a one-on-one, face-to-face medically necessary office visit.
• Billing Code: Use code T1013 for interpreter services. Providers can submit claims for a maximum of 8 units per office visit, with each unit representing 15 minutes.
• Reimbursement Rate: As of 15 de octubre de 2024, the standard reimbursement rate is $17.65 per 15-minute unit. The time billed for interpretation services cannot exceed the length of the office visit.
• Claim Submission: Providers should bill both the office visit (if total cost is not covered by Medicare plan) and the interpreter service on the same claim form. Interpreter services provided by the provider or their staff are not eligible for reimbursement. See Billing Guidelines for the Provision of Interpreter Services in Fee for Service Medicaid.