Licensed Marriage and Family Therapist (LMFT) - PT (83) (839)

Licensed Marriage and Family Therapist (LMFT) - PT (83) (839)

Kentucky Medicaid identifies licensed marriage and family therapist (LMFT) services Provider Type (83) individual or (839) group. To enroll in and bill Kentucky Medicaid LMFT services providers must be:

Covered Services

If determined medically necessary, LMFT providers independently diagnose and treat mental health and substance abuse problems for individuals, couples and families.

LMFTs and LMFTAs must meet the coverage provisions and requirements of 907 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 LMFT services is in accordance with the Behavioral Health Fee Schedule defined in 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.

Claims Submission

Kentucky Medicaid currently contracts with Gainwell​ to process the Kentucky Medicaid fee-for-service (FFS) claims. Each MCO processes its own claims.

Coding Kentucky Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky 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 Gainwell. 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 of the date of service or six months from the Medicare pay date whichever is longer, or within 12 months of the last date of Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.

Provider Contact Information

  • FFS Billing Questions - Gainwell​ - (800) 807-1232
  • Provider Questions - (855) 824-5615
  • Provider Enrollment or Revalidation - (877) 838-5085
  • 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

Report Fraud and Abuse

  • (800) 372-2970

Regulations

  • KRS 335 Social Workers and Professional Counselors
  • KRS 335.330 Initial fee for licensure - Requirements for certification
  • KRS 335.332 Application for marriage and family therapist associate permit - Qualifying experience for licensure - Fees
  • 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

Provider Letters

Billing Information

Contact Information

53