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:
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.
Verify eligibility by contacting the automated voice response system toll-free at (800) 807-1301 or use the web-based KYHealth-Net System.
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.
CareWise provides prior authorizations for fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.
Kentucky Medicaid currently contracts with DXC 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.
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.
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 - DXC - (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
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