Is music therapy reimbursable service? PDF Print E-mail

Medicare
Since 1994, music therapy has been identified as a reimbursable service under benefits for Partial Hospitalization Programs (PHP). Falling under the heading of Activity Therapy, the interventions cannot be purely recreational or diversionary in nature and must be individualized and based on goals specified in the treatment plan. The current HCPCS Code for PHP is G0176.

The music therapy must be considered an active treatment by meeting the following criteria:

  1. Be prescribed by a physician;

  2. Be reasonable and necessary for the treatment of the individual’s illness or injury;

  3. Be goal directed and based on a documented treatment plan;

  4. The goal of treatment cannot be to merely maintain current level of functioning; the individual must exhibit some level of improvement.

Medicaid
As Medicaid programs vary from state-to-state, so do the Medicaid coverage avenues for music therapy services. Some private practice music therapists have successfully applied for Medicaid provider numbers within their states. Some states offer waiver programs in which music therapy can be covered. In some situations, although music therapy is not specifically listed as a covered service, due to functional outcomes achieved, music therapy interventions can fall under an existing treatment category such as community support, rehabilitation, or habilitation.

Examples:

Arizona

Medicaid coverage for music therapy provided to individuals with developmental disabilities; originally recognized as a habilitation service but also considered as a socialization service.

Minnesota
Individual music therapist received provider number to service clients with mental illness and developmental disabilities. Waiver program for children with developmental disabilities provides coverage for music therapy.

Pennsylvania
Department of Aging Waiver program allows Medicaid payment for music therapy provided in a community based setting. Music therapy is listed under health and mental health related counseling services.

North Carolina
Medicaid reimbursement is available for music therapy services through the Community Alternatives Program (CAP) for clients with developmental disabilities.

Indiana
Waiver program for children with developmental disabilities offers coverage for music therapy.

Michigan
Music therapy is a covered service under the state’s Medicaid Children’s Waiver Program.

Private Insurance

  • The number of success stories involving third party reimbursement for the provision of music therapy services continues to grow. Over the past twelve years a growing public demand for music therapy services has been accompanied by a demand for third party reimbursement. In response to the increasing demand the music therapy profession has worked to facilitate the reimbursement process for clients of music therapy services.

  • The American Music Therapy Association now estimates that at least 20% of music therapists receive third party reimbursement for the services they provide. This number is expected to increase exponentially as music therapy occupies a strong position in the health care industry.

  • Insurance companies are recognizing the advantages of including music therapy as a benefit as they respond to the increasing market demand for greater patient choice of health care services. Companies like, Blue Cross/Blue Shield, Humana, Great West Life, Aetna, Metropolitan, and Provident have reimbursed for music therapy services on a case-by-case basis, based on medical necessity.

  • Music therapy is comparable to other health professions like occupational therapy and physical therapy in that individual assessments are provided for each client, service must be found reasonable and necessary for the individual’s illness or injury and interventions include a goal-directed documented treatment plan.

  • Like other therapies, music therapy is typically pre-approved for coverage or reimbursement, and is found to be reimbursable when deemed medically necessary to reach the treatment goals of the individual patient. Therefore, reimbursement for services is determined on a case-by-case basis and is available in a large variety of health care settings, with patients with varying diagnoses.

Other Sources
Additional sources for reimbursement and financing of music therapy services include: many state departments of mental health, state departments of mental retardation/developmental disabilities, state adoption subsidy programs, private auto insurance, employee worker’s compensation, county boards of mental retardation/developmental disabilities, IDEA Part B related services funds, foundations, grants, and private pay.

 
< Prev   Next >