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 service providers must be:
- Licensed in Kentucky with Board of Licensure for Marriage and Family Therapists.
- LMFTs and licensed marriage and family therapist associates(LMFTA) must be licensed according to KRS 335.330 and KRS 335.332 respectively.
- Enrolled as an active Medicaid provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary served.
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 Technologies 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 Technologies. 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 Inquiry Resources
If you have questions or need more information, please review the Medicaid Contacts List to find additional support from Kentucky Medicaid.