LADC billing

sfoster 7 months ago in Billing/Electronic Modules updated by Karen P 6 months ago 9

Hello, looking for help in billing for a newly licensed LADC. She should be getting her license in June and then begin the process of credentialing w/payers, etc. What codes are used when billing at an outpatient behavioral health facility for a LADC? Thus far the only codes we use are outpatient codes for; LMFT, LISCW, LPC, etc. Any guidance would be greatly appreciated! Thanks, Sara

First - most payers don't credential LADCs.

Second - what services is this LADC going to be providing?

Health Partners might need LADC's credentialed for IOP actually but I haven't found any other payers that require this. I don't agree with Health Partners needing this because our IOP services are billed as a facility claim under our Group NPI and no individual providers are listed on the claims. Just unique....

I think you're right, LaVonne, in that HP might be the only payer in MN to credential LADCs.

We're also contracted as a facility, but if you read the Provider Agreement, you do agree to credential all staff regardless of facility or professional billing. 

Your LADC can bill under a provisional license as long as the services she provides are signed off on by her supervisor who is an LADC.  We bill with our agency NPI not the LADC's NPI.  Most insurances don't require/credential LADCs.  The codes depend on the services being provided.  Also each insurance requires different modifiers.  Hope that helps.

The only staff that we credential with HP is our director of our SUD program.  Haven't had any issues with billing.

I appreciate that feedback Karen. 

Let me just begin by saying I feel outside my comfort zone here! This whole LADC thing is brand new to me. Having said that, from what I understand under her LADC, she will only be doing assessments, then she'll bill under her LPCC for the ongoing therapy. Does this make sense? So what codes do I need to add? Is there a code similar to a 90791?

When I spoke to Bridget, our newly licensed LADC, she mentioned a H0001 code. What is this code for? As you can see I really am needing to start with the very basics.

Also, I'm a bit confused as to what a Rule 25 Assessment is?  

Thank you so much! Sara

The H0001 is used for billing assessments.  Your staff needs to bill under her LADC NPI or the agency NPI for SUD.  Any SUD services that your staff bills can't be billed under her LPCC.