Licensed Psychologist – PT (89) (899)

Licensed Psychologist – PT (89) (899)

Licensed Psychologist services are recognized in Kentucky Medicaid as Provider Type (89) individual, or (899) group and may bill Kentucky Medicaid using these provider type numbers.  In order for any Licensed Psychologist or Licensed Psychologist group to provide services to a Medicaid beneficiary, it must

  • be licensed in the state in which it is located
  • Licensed Psychologistmust be licensed in accordance with KRS 319.050
  • be enrolled with Kentucky Medicaid
  • be enrolled with the Managed Care Organization (MCO) of any beneficiary it wishes to treat

Covered Services

What are Licensed Psychological services?  If determined medically necessary, they are licensed professionals who are qualified to provide direct services beneficiaries. Their work may include administering and interpreting cognitive and personality tests, diagnosing mental illness, creating treatment plans, and conducting psychotherapy.

How do I verify eligibility? Once eligibility has been obtained, you may verify continued eligibility by one of the following methods:

  • by contacting the Automated Voice Response System at (800) 807-1301
  • by using the Web-basedKYHealth-Net System

Licensed Psychologists must meet the coverage provisions and requirements set forth in 907 KAR 15:010 in order 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 for in which they participate.

Non-Covered Services: Procedures not considered medically necessary shall not be covered by Kentucky Medicaid.

Reimbursement: Reimbursement for Licensed Psychologist services is in accordance with the Behavioral Health Fee Schedule and is 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.

Prior Authorization

For Fee for Service beneficiaries who require prior authorization for additional services that are deemed medically necessary, contact CareWise. For MCO beneficiaries who require prior authorization for additional services that are medically necessary, contact the beneficiaries MCO for more information.

Claims Submission

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 utilizes 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. (eff: 10/1/15) Kentucky Medicaid requires the use of UB-04 billing forms. Providers must bill using the Revenue Codes listed in the back of the billing manual.

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 in question, 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 in question, if appealing an MCO claim.

Provider Contact Information

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 

Report Fraud and Abuse
(800) 372-2970

Regulations

KRS 319.050 (Examination for license -- Fee -- Supervision and temporary licensure -- Designation as "health service provider.")
KRS 319.056  ("Certified psychologist with autonomous functioning" -- "Certified psychologist" -- Practice and title authorization)
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 Letters

Notification of KY Medicaid Partner Portal Application (KYMPPA) Update Issued 7/26/2019
Multi Behavioral Health Provider Letter - Revisions to Behavioral Health and Substance Abuse Services fee Schedules 01/01/2019 Issued 4/15/2019
Behavioral Health and Substance Abuse Services Fee Schedules Issued 2/7/2019
General Provider Letter #A-103 - IMD Expansion Issued 1/2/2018
Provider Letter regarding Ordering, Referring Prescribing Providers Issued 2/1/2017  

Billing Information



Contact Information

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