Author Topic: LPC Billing to Medicare for FQHC  (Read 105 times)

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LPC Billing to Medicare for FQHC
« on: April 20, 2021, 10:37:31 AM »
Good morning everyone. I have scoured CMS.gov and as always am unable to find what I'm looking for due to the wealth of information on that sight so I have registered here in hopes of finding the answers I seek!

I am new to FQHC billing, been doing it for 6 months, and have never dealt with Behavioral Health on any level until I got to where I'm at. I am at a Virginia FQHC. I have come to the conclusion so far that Medicare does not reimburse LPC's for Behavioral Health services. I was wondering, does this change if you bill under a supervising physician, or would it still be denied due to the LPC still being the servicing provider?

As of right now we are just billing Medicare to get the denial to bill to secondary and cross our fingers that they pay for it. I felt like that was the wrong way to go about it. Any information would be GREATLY appreciated!

Michele

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Re: LPC Billing to Medicare for FQHC
« Reply #1 on: April 20, 2021, 11:52:25 AM »
Medicare does not credential LPCs so that is correct that they do not reimburse when an LPC is the rendering provider.  Now the issue switches over to a legal issue of can the services of an LPC be billed under a supervising physician.  I found this article from the national council for behavioral health regarding Medicare and mental health services rendered by auxiliary personal such as LPCs:

https://www.thenationalcouncil.org/wp-content/uploads/2020/04/NCBH_IncidentTo_Toolkit.pdf?daf=375ateTbd56

According to the article, billing for auxiliary personal can be consider "incident to" billing if the services are furnished as an "integral, although incidental" part of the physician's personal professional services.  So if the supervising provider feels that this statement is accurate, then the billing can be done under the supervising physician.  The article explains it in greater detail.

I hope that helps!

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Re: LPC Billing to Medicare for FQHC
« Reply #2 on: April 20, 2021, 12:38:57 PM »
Thank you SO much for this! I've read through a small portion so far and it seems to hold the information I need. I really appreciate it.

Michele

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Re: LPC Billing to Medicare for FQHC
« Reply #3 on: April 20, 2021, 08:37:44 PM »
You are welcome.  Glad I could help.   :)
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Re: LPC Billing to Medicare for FQHC
« Reply #3 on: April 20, 2021, 08:37:44 PM »