Health & Behavior codes

[JHillery]

Is there a licensure level requirement for billing H&B codes? We have health coaches that perform this service but they are not officially licensed in any manner.

 

[TThivierge]

Unlicensed B& H providers=HCPCS modifiers

Hi if you are billing Medicaid for H&B services usually they must go thru some type of training; seminar or online quiz and get a certification, plus have BA degree and been involved in behavior health arena for some time. Medicaid in your state may require this process. In addition, the unlicensed professional will have to have session reviewed by a licensed LPC or LCSW to ensure guides followed; something like a utilization review check of quality care. Usually commercial insurance companies will not pay for unlicensed therapist or health workers.

Also ensure your guidelines are checked for billing Medicaid in your state for H&B college degree workers completing care in counseling teens at school services or case management of MR clients. A contract may be required with your business and state Medicaid office.

Also if you look in HCPCS manual , in back at Level II Appendix 2 modifiers (HM HN modifiers) tagged onto HCPCS behavioral codes starting with H, T or S prefixed billing codes. These modifiers denoting which service unlicensed staff can treat clients or work in.

Hope this helps you