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Billing Medicare when out of network

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I work with a lot of LPC's that are master's level. Medicare does not recognize master's level clinicians. They can not become in network providers but more importantly, claims are not processed to be denied by Medicare or Medicaid. People come to see a master's level provider with medicare or Medicaid and have secondary insurance. So they want us to bill Medicare and get the denial and use that to bill the secondary. But Medicare does not even acknowledge they have received and rejected the claims. They never show in the Medicare system and we never receive correspondence back on these claims. So we can not bill the secondary either.

Has anyone ever figured out a way around this?

Thank you

You are correct that licensed professional counselors are a mental health discipline that is not covered by Medicare.  Therefore, Medicare will not process claims received from LPCs, just as they will not process claims received from my plumber.

Those commercial insurance companies that cover LPCs know this.  Each company would have it's own way of handling this.  You would need to contact each insurance that your LPC is a participating provider with and ask how they want you to handle this situation.

I encounter this very often and I have contacted various companies to see how to handle this.

One carrier, we file the claim as normal then call in to have it reprocessed.

Another carrier, we file by paper with an explanation as well as the Medicare guidelines stating they can not bill Medicare.

It is definitely up to the carrier on how this is handled.

Thank you both for your responses. I will work with your suggestions and glad to see something is working for you!!


MY non Medicare clients just simply tell Medicare Patients that they are NOT Medicare providers. From there it's patients responsibility and choice. For those that come to see us anyway, they are treated as cash patients.


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