Expansion of Mental Health Professionals (IB 24-25)
Date: 08/01/24
Louisiana Healthcare Connections is sharing with providers a recent publication for an updated reimbursement services fee schedule for Mental Health Providers (IB 24-25).
Pending federal approval by the Centers for Medicare and Medicaid Services (CMS), Louisiana Medicaid will reimburse services delivered by provisionally licensed professional counselors (PLPC), provisionally licensed marriage and family therapists (PLMFT), and licensed master social workers (LMSW). The Louisiana Department of Health requested an effective date of August 1, 2024, via State Plan Amendment (SPA) submission to CMS.
Following CMS approval, which is projected to occur around September 1, 2024, the rates for PLPCs, PLMFTs, and LMSWs will be added to the Specialized Behavioral Health Services (SBHS) fee schedule and an update will be provided via this Informational Bulletin once received.
Allowable services are to be billed using appropriate Current Procedural Terminology (CPT) codes listed below. PLPCs, PLMFTs and LMSWs shall practice within the scope of practice of their respective Louisiana professional licensing board and shall be rendering providers only.
Any claim billed independently by a PLPC, PLMFT or LMSW will be denied.
| Code | Description | Age | Licensed MSW (Modifier U4) | Provisionally LPC/LMFT (Modifier UA) |
|---|---|---|---|---|
| 90785 | Interactive Complexity, Add on | 0+ | $2.06 | $2.06 |
| 90791 | Psychiatric Diagnostic Evaluation | 0+ | $65.03 | $65.03 |
| 90832 | Psychotherapy, 30 Minutes with Patient Present | 0+ | $28.59 | $28.59 |
| 90834 | Psychotherapy, 45 Minutes with Patient Present | 0-20 | $40.25 | $40.25 |
| 90834 | Psychotherapy, 45 Minutes with Patient Present | 21+ | $41.86 | $41.86 |
| 90837 | Psychotherapy, 60 Minutes with Patient Present | 0-20 | $59.27 | $59.27 |
| 90837 | Psychotherapy, 60 Minutes with Patient Present | 21+ | $46.04 | $46.04 |
| 90839 | Psychotherapy for Crisit; First 60 Minutes | 0-20 | $74.16 | $74.16 |
| 90839 | Psychotherapy for Crisit; First 60 Minutes | 21+ | $75.32 | $75.32 |
| 90840 | Psychotherapy for Crisit; Each Additional 30 Minutes Add On | 0-20 | $36.90 | $36.90 |
| 90840 | Psychotherapy for Crisit; Each Additional 30 Minutes Add On | 21+ | $30.13 | $30.13 |
90840 | Psychotherapy for Crisit; Each Additional 30 Minutes Add On | 21+ | $30.13 | $30.13 |
90846 | Family Psychotherapy Without Patient Present | 0+ | $37.57 | $37.57 |
90847 | Family Psychotherapy Without Patient Present | 0+ | $46.60 | $46.60 |
90853 | Group Psychotherapy | 0+ | $13.23 | $13.23 |
96156 | Health Behavior Assessment/ Reassessment | 0-20 | $7.86 | $7.86 |
96156 | Health Behavior Assessment/ Reassessment | 21+ | $9.82 | $9.82 |
96158 | Health Behavior Intervention Individual, Face-to-Face: First 30 Minutes | 0-20 | $14.47 | $14.47 |
96158 | Health Behavior Intervention Individual, Face-to-Face: First 30 Minutes | 21+ | $18.10 | $18.10 |
96159 | Health Behavior Intervention Individual, Face-to-Face: Each Additional 15 Minutes | 0-20 | $7.24 | $7.24 |
96159 | Health Behavior Intervention Individual, Face-to-Face: Each Additional 15 Minutes | 21+ | $9.05 | $9.05 |
96164 | Health Behavior Intervention Group, Face-to-Face: First 30 Minutes | 0-20 | $3.47 | $3.47 |
96165 | Health Behavior Intervention, Group, Face-to-Face: Each Additional 15 Minutes | 0-20 | $1.73 | $1.73 |
96164 | Health Behavior Intervention, Group, Face-to-Face: First 30 Minutes | 21+ | $4.33 | $4.33 |
96165 | Health Behavior Intervention, Group, Face-to-Face: Each Additional 15 Minutes | 21+ | $2.17 | $2.17 |
96167 | Health Behavior Intervention, Family with Patient Present, Face-to-Face; First 30 Minutes | 0-20 | $14.22 | $14.22 |
96167 | Health Behavior Intervention, Family with Patient Present, Face-to-Face; First 30 Minutes | 21+ | $17.76 | $17.76 |
96168 | Health Behavior Intervention, Family with Patient Present, Face-to-Face; Each Additional 15 Minutes | 0-20 | $7.11 | $7.11 |
96168 | Health Behavior Intervention, Family with Patient Present, Face-to-Face; Each Additional 15 Minutes | 21+ | $8.88 | $8.88 |
The Outpatient Therapy by Licensed Practitioners section of the Medicaid Behavioral Health Services Provider Manual will be updated to reflect policy and additional billing guidance associated with services provided by PLPCs, PLMFTs and LMSWs. Monitor Medicaid Provider Resources for updated versions of the SBHS fee schedule and provider manual.
Louisiana Healthcare Connections will update our claims processing systems to properly adjudicate behavioral health claims for PLPCs, PLMFTs and LMSWs, within 60 days of the date of this Informational Bulletin. Claims will be automatically recycled with no action needed by the provider. For dates of service on or after August 1, 2024, we will recycle any claims that were not paid in accordance with these changes within 15 days of implementing the system changes.