Licensed Professional Clinical Counselors (LPCC)services are recognized in Kentucky Medicaid as Provider Type (81) individual, or (819) group. To enroll and bill Kentucky Medicaid, LPCC and LPCCA service providers must be:

• Licensed in Kentucky with the Board of Professional Licensing
  
• Licensed Professional Clinical Counselors (LPCC) and Licensed Professional Clinical Counselors Associates (LPCCA) must be licensed according to KRS 335.525.
  
• Enrolled as a Medicaid active provider and, if applicable, enrolled with the managed care organization (MCO)of any beneficiary served.

Covered Services

If determined medically necessary, LPCCs are doctoral or masters-level mental health service providers, trained to work with individuals, families, and groups in treating mental, behavioral, and emotional problems and disorders.

LPCCs and LPCCAs service providers 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.

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 LPCC 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

CareWise provides prior authorizations for FFS beneficiaries. Each MCO provides prior authorization for its beneficiaries.

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.  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 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

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