Licensed Clinical Alcohol and Drug Counselors (LCADC) - PT 67(9)

Licensed Clinical Alcohol and Drug Counselors (LCADC) - PT 67(9)

Kentucky Medicaid identifies licensed clinical alcohol and drug counselors (LCADC) as Provider Type (67) individual or (679) group. To enroll and bill Kentucky Medicaid, LCADC service providers must be:

Covered Services

If determined medically necessary, LDAC providers engage professionally and for compensation in alcohol and drug counseling and appraisal activities by providing services involving the application of counseling principles and methods in the diagnosis, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions of individuals or groups.

Licensed clinical alcohol and drug counselors, associates, certified alcohol and drug counselors and alcohol and drug peer support specialists must meet the coverage provisions of 07 KAR 15:010 to provide covered services. All services must be performed within the scope of practice for any provider. Providers must follow Kentucky Medicaid regulations and the requirements of the MCO in which they participate.

Verifying eligibility

Verify eligibility by contacting the automated voice response system toll-free at (800) 807-1301 or use the web-based KYHealth-Net System.

Reimbursement

Reimbursement for services is in accordance with 907 KAR 15:015.

Duplication of Service

Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the service is covered during the same time period.

Prior Authorization

CareWise provides prior authorizations for fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.

Claims Submission

Kentucky Medicaid currently contracts with DXC to process the Kentucky FFS claims each MCO processes its own claims.

Coding

KY Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes mutually exclusive or incidental. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. KY Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. KY Medicaid requires the use of CMS 1500 billing forms. Providers need to bill KY Medicaid using the correct CPT codes.

Claim Appeals

Appeal requests made on denied FFS claims must be submitted to DXC. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO if appealing an MCO claim.

Timely Filing

Claims must be received within 12 months from the date of service (DOS) or 6 months from the Medicare pay date whichever is longer, or within 12 months from the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.

Provider Contact Information

Billing Questions - DXC - (800) 807-1232
Provider Questions - (855) 824-5615
KyHealth.net assistance - DXC - (800) 205-4696
CHFS DMS BH and SU Inquires - (502) 564-6890
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drug (PAD) List - Pharmacy Branch - (502) 564-6890

Provider MCO Information

Anthem - (800) 205-5870 
Aetna Better Health of KY - (855) 300-5528 
Humana - (855) 852-7005
Passport Health Plan- (800) 578-0775
WellCare of KY - (877) 389-9457 

​Report Fraud and Abuse

(800) 372-2970

Regulations

KRS 309 Alcohol and drug counseling

KRS 309.0831 Requirements for registration as an alcohol and drug peer, support specialist,

KRS 309.0832 Requirements for licensure as a licensed clinical alcohol and drug counselor 

KRS 309.0833 Requirements for licensure as a licensed clinical alcohol and drug counselor associate

907 KAR- Cabinet for Health and Family Services - DMS Title page

907 KAR 3:130  Medical necessity and clinically appropriate determination basis 

907 KAR 15:010 Coverage provisions and requirements regarding behavioral health services provided by individual behavioral health providers, behavioral health provider groups and behavioral health multi-specialty groups

907 KAR 15:015 Reimbursement provisions and requirements for behavioral health services provided by individual behavioral health providers, behavioral health provider groups or behavioral health multi-specialty groups

Provider Resources

PT 67 - LCADC Provider Summary
PT 67(9) - LCADC Group Provider Summary

Provider Letters

Provider Letter #A-107: COVID-19 Presumptive Eligibility 

Provider Letter #A-106: COVID-19 Guidance - Telehealth

Provider Letter A-105: COVID-19 Guidance for all Medicaid Providers

General Provider Letter #A-103 - IMD Expansion

Provider Letter regarding Ordering, Referring Prescribing Providers

Billing Information


Contact Information