Provider Notice 2019-43: LPC and LMFT Reimbursement in FQHCs and RHCs

Date: 11/15/19

On behalf of Louisiana Department of Health, Louisiana Healthcare Connections would like to inform providers about upcoming reimbursement changes.

Reimbursement for licensed professional counselors (LPC) and licensed marriage and family therapists (LMFT) will be considered as “other” ambulatory services in rural health clinics (RHC) and federally qualified health centers (FQHC). Reimbursement for these services will be the Louisiana Medicaid established alternative payment methodology (APM) rate for behavioral health services provided in FQHCs and RHCs. This change will be effective retroactively to April 1, 2019.
 
The APM allows reimbursement for behavioral health services equal to the all-inclusive prospective payment system rate (PPS) on file for the date of services. This reimbursement will be in addition to any all-inclusive prospective payment system rate on the same date for a medical or dental visit.
 
For billing purposes, HCPCS Code H2020 will be used for reimbursement of the APM rate to FQHC and RHC providers. Going forward RHC and FQHC providers can bill the T1015, D0999 and H2020 on the same day of service and be reimbursed for all three HCPCS codes at their PPS rate.
 
LPC and LFMT services are governed by Medicaid policies and procedures specific to each program. The policies and procedures for the FQHC and RHC services program do not apply to these “other” ambulatory services. The provider manual for these services is located at https://www.lamedicaid.com/provweb1/Providermanuals/manuals/BHS/BHS.pdf.

Louisiana Healthcare Connections will update all claims configurations prior to November 30, 2019. Providers may review HPA 19-17 for additional information.