Medical Billing Forum

Billing => Billing => Topic started by: TerriTye on January 29, 2014, 08:05:14 AM

Title: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: TerriTye on January 29, 2014, 08:05:14 AM
I currently bill for a LCSW. She also has an LPCA. The LPCA has an individual NPI. I'm unclear on whether she (the LPCA) can bill Medicare, Medicaid, etc.
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: rdmoore2003 on January 29, 2014, 08:26:18 AM
medicare does not recognize lpc's.
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: TerriTye on January 29, 2014, 08:35:23 AM
Does any insurance co recognize LPC's?
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: Michele on January 29, 2014, 08:43:23 AM
There are not a lot of insurance carriers who recognize LPCs.  I personally do not know of any.  There are probably some smaller carriers that may allow them for certain plans, but they are not widely accepted.  They can bill but it will be out of network and then it will depend on if the insurance plans have OON benefits and if they allow for LPCs even OON. 
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: rdmoore2003 on January 29, 2014, 08:46:40 AM
There are not a lot of insurance carriers who recognize LPCs.  I personally do not know of any.  There are probably some smaller carriers that may allow them for certain plans, but they are not widely accepted.  They can bill but it will be out of network and then it will depend on if the insurance plans have OON benefits and if they allow for LPCs even OON.

I disagree.   Only medicare & medicaid do not cover in my experience.   My lpc's are networked with bc/bs, cigna, tricare, etc.
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: TerriTye on January 29, 2014, 08:50:09 AM
Does it maybe vary regarding state? I am in Kentucky.
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: rdmoore2003 on January 29, 2014, 08:55:26 AM
Does it maybe vary regarding state? I am in Kentucky.

I would contact your insurance companies to see which will cover.   For example, blue cross/blue shield in my state, Louisiana, covers lpc's.   When we get benefits from bc/bs out of state, we are always told that if the benefit for mental health is covered and they see an lpc, it is covered if the provider is providing care under their scope of licensure.  I have never had any issues.    With that said, there are a couple of northern states that have exclusions under their mental health benefits that state something along the lines of, covered by md or lcsw only.     Lpc's reimbursement rates are a bit lower than psychiatrists and medical psychologists, just a bit.
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: Michele on January 29, 2014, 11:14:48 AM
Good to know.  In our area, LPCs are not covered.  But I think TX might have a few insurers that cover them as well now that my brain is turning.  It must vary by state.
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: Michele on January 29, 2014, 11:15:17 AM
I am in NY in case that wasn't clear.   :)
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: PMRNC on January 29, 2014, 12:26:29 PM
MEDICARE/MEDICAID won't recognize an LPC but I know carriers who will in NY. I took on a temporary billing project for an LPC about 2 years ago we had a few carriers that paid her.  I know Magellan will cover them.
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: Billing2 on January 29, 2014, 08:59:42 PM
One of  my office has 9 LPC and we get paid. The only state I have found that won't pay is TN.
The LPC board is working on being able to bill Medicare. I think we will see it soon. The LCSW board is not fighting it like they had been.
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: mcmsouth on May 05, 2014, 09:06:17 PM
Bill for LPC 's in Georgia and have no issue for the private insurance companies.  FYI, I have had a few Blue policies that originate out of Alabama and Carolina's that do not cover LMFT's.
Title: Re: LPCA - LICENSED PROFESSIONAL COUNSELOR ASSOCIATE
Post by: shanbull on May 06, 2014, 09:12:31 AM
In our area we are able to bill for anyone with at least a bachelor's degree under the incident-to provision with supervision by a psychiatrist under the psychiatrist's NPI to Medicare/Medicaid and most private insurers. Make sure to check out the viability of policies like that in addition to your area's LCD's.