Question Behavioral Health

ckeeney

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South Bend Indiana
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Are you talking about something similar to incident to rules? The rendering behavioral health provider needs to be credentialed and bill under their own credential for behavioral health services. Medicare does not allow billing under a supervising provider for behavioral health services. Other payers do allow or require that you bill under a supervising physician/PsyD with appropriate modifiers.

From our MAC:
Providers or Suppliers not eligible to enroll in Medicare
The following is a list of providers or suppliers not eligible to enroll in Medicare. If a provider is not eligible to enroll he/she or the organization is not eligible to receive payment from Medicare.
  • Acupuncturist
  • Assisted Living Facility
  • Birthing Center
  • Certified Alcohol and Drug Counselor
  • Certified Social Worker
  • Drug and Alcohol Rehabilitation Counselor
  • Hearing Aid Center/Dealer
  • Licensed Alcoholic and Drug Counselor
  • Licensed Massage Therapist
  • Licensed Practical Nurse
  • Licensed Professional Counselor
  • Marriage Family Therapist
  • Master of Social Work
  • Mental Health Counselor
  • National Certified Counselor
  • Occupational Therapist Assistant
  • Physical Therapist Assistant
  • Registered Nurse
  • Speech and Hearing Center
  • Substance Abuse Facility
 
Last edited:

ckeeney

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South Bend Indiana
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I do not believe this to be true. And see the following article below.

Here is a Medlearn article on Mental Health (and incident-to). In that article, it says that an LCSW cannot bill for staff services as incident-to. So the answer to the original question is no.
Just to clarify, I did not say that for Medicare an LCSW can bill for staff services. I stated "Medicare does not allow billing under a supervising provider for behavioral health services " and the information from the MAC also clearly states that the type of credential the original post was referring to is not eligible for enrolling in Medicare and therefore those services provided by this staff are not eligible for reimbursement.
 
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Clovis, CA
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... therefore those services provided by this staff are not eligible for reimbursement.
They are not eligible for reimbursement to those staff members, but that does not mean they are not eligible for reimbursement at all. The reimbursement goes to the supervising provider.

I am unclear on what you mean by "Medicare does not allow billing under a supervising provider for behavioral health services", because it clearly DOES allow that. Does it allow it for an LCSW? No.

If the supervising provider was a licensed clinical psychologist, the MSW could provide the services and they could be billed incident-to for Medicare. The person performing the service does not have to be enrolled with, or eligible to enroll with Medicare to have their services billed incident to. Otherwise, no injection given by a medical assistant could ever be billed incident-to.
 
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