Lcpc

LCPC sees patient but there is also a supervising PsyD, can the claim be billed under the PsyD sinced PsyD is singning off chart?
Quick response needed, please.

re: LCPC

If the LCPC sees the Clt and writes the notes for that contact, the LCPC level should be the rate at which that bill for services is submitted.
Not sure what you mean by the "PsyD is signing off the chart", as there is no regulation (insurance or otherwise) of which I'm aware that requires that, unless the LCPC is ALSO working on "licensure track hours" for either a PhD or a PsyD?

re: LCPC

Both PsyD and LCPC sees the patient and both singning on the chart. Can we bill the total visit under the PsyD? If the LCPC is not on par with the insurance carrier?

re: LCPC

you cannot bill from one provider for services rendered by a different provider - just as you cannot bill a Physical Therapy service code when you are a nurse. The individual licensure requires the billing follow the service provided - otherwise it would appear that fraudulent billing practices are being used by persons not licensed to provide a given service.

re: LCPC

So, if the PsyD is with the LCPC when seeing patient, the entire visit cannot be billed under the Psyd ony? How will it be billed then?

Also if LCPC is working on "licensure track hours" with Psyd, how can the claim be billed then?
I have just started billing for this type of providers and still trying to understand. Thank you so much.

re: LCPC

a lot will depend on the licensure requirements of your state, which sets the parameters by which licensure hours are collected and documented, and whether the primary provider must be IN the room, or behind a one-way glass, or videotaped, . . . etc. . . . . . Those are state-by-state licensure issues, and not precisely that of CPT® codes. . . . otherwise, why would the PsyD be in the room with the LCPC when only one can bill the contact? . . . and/or why would the LCPC be writing the note? Whomever provides the service and writes the note (should be the same person) is whom should bill.

re: LCPC

Yes you can bill that way, it's covered under Medicare's incident-to provision. This is direct from Chapter 15 of the Medicare Benefit Policy Manual:

"For purposes of this section a noninstitutional setting means all settings other than a hospital or skilled nursing facility Medicare pays for services and supplies (including drug and biologicals which are not usually self-administered) that are furnished incident to a physician’s or other
practitioner’s services, **are commonly included in the physician’s or practitioner’s bills**, and for which payment is not made under a separate benefit category listed in §1861(s) of the Act. Carriers and intermediaries must not apply incident to requirements to services having their own benefit category. Rather, these services should meet the requirements of their own benefit category. For example, diagnostic tests are covered under §1861(s)(3) of the Act and are subject to their own coverage requirements. Depending on the particular tests, **the supervision requirement for diagnostic tests or other services may be
more or less stringent than supervision requirements for services and supplies furnished incident to physician’s or other practitioner’s services. ** Diagnostic tests need not also meet the incident to requirement in this section. Likewise, pneumococcal, influenza, and hepatitis B vaccines are covered under §1861(s)(10) of the Act and need not also meet incident to requirements. (Physician assistants, nurse practitioners, clinical nurse specialists, certified nurse midwives, clinical psychologists, clinical social workers, physical therapists and occupational therapists all have their own benefit categories and
may provide services without direct physician supervision and bill directly for these
services. When their services are provided as auxiliary personnel (see under direct
physician supervision, they may be covered as incident to services, in which case the incident to requirements would apply.

For purposes of this section, physician means physician or other practitioner (physician, physician assistant, nurse practitioner, clinical nurse specialist, nurse midwife, and clinical psychologist) authorized by the Act to receive payment for services incident to
his or her own services.

To be covered incident to the services of a physician or other practitioner, services and
supplies must be:

• An integral, although incidental, part of the physician’s professional service (see
§60.1);

• Commonly rendered without charge or included in the physician’s bill (see
§60.1A);

• Of a type that are commonly furnished in physician’s offices or clinics (see
§60.1A);

• Furnished by the physician or by auxiliary personnel under the physician’s direct
supervision (see §60.1B).


We checked with Medicare on this and they confirmed it's allowed, we simply add a modifier to indicate the services were provided by someone with a bachelor's degree (obviously not the psychiatrist on the claim), and they are able to process the claim based on that information.

re: LCPC

Oops, disregard this post.