We hope this page provides answers to the most frequently asked questions (FAQs) we receive about funding for music therapy services at LIH.
Can music therapy service be billed directly to MA?
No. Music therapy cannot be billed directly to MA. Please see the following question about additional programs that may be available.
Do state programs provide funding for music therapy services?
Yes, however, funding is based on state/location and prior authorization/approval.
Many states have programs available to assist individuals with needs related to developmental delays, neurologic impairment, etc. LIH is based out of Southwestern Wisconsin and we are very thankful to have various state programs available for our clients in Wisconsin as well as across the river in Minnesota. These programs often support the incorporation of music therapy services to target functional goals that are deemed therapeutic and necessary. These programs are coordinated by a social worker, case worker, service facilitator, consultant, or other individual whose role is to help navigate the program and provide guidance over what may or may not be allowable within the program. Many clients and consumers at LIH receive services through state programs such as the Children’s Long-Term Support (CLTS) Waiver, Family Support Program (FSP), IRIS, Family Care (FAMC) (local programs MCOs Inclusa and Care Wisconsin), and the Comprehensive Community Services (CCS) program. In Minnesota, music therapy is an available service through programs such as the Consumer Directed Community Supports (CDCS) program and Consumer Support Grants. The best place to begin is with the care team of the individual who may be in need of services. Identify areas the areas of need you would like to target in music therapy and ask the care team if music therapy services could be authorized to assist in meeting or working towards these functional goals. ***Please know that enrollment in one of these programs is not a guarantee that music therapy services will be approved or available; however, many individuals may not be aware that music therapy can be provided through these programs. If a potential client is enrolled in one of these programs already we strongly encourage you to reach out to the assigned social worker, case manager, consultant, etc. to ask if music therapy can be added to his/her service plan. LIH is not able to provide services through these state programs without prior approval/authorization.
Are there any grants or scholarships available for music therapy services?
Yes! The Greater La Crosse Region is blessed to have a few different options for community-based grants that have supported individuals in getting started with services. These currently include the La Crosse Area Autism Foundation, the Down Syndrome Association of Wisconsin, and the Children’s Miracle Network. You can find more information regarding grant application under the RESOURCES tab on our website. Please know that LIH is not responsible for completing or submitting a grant request, nor does LIH have any weight in the decision-making process that goes in to determining grant recipients. LIH strongly encourages families to consider cost-sharing with family funds and grant funds to extend the duration of services that can be provided with the help of grant award.
Do private health plans cover music therapy?
Sometimes. Insurance coverage for music therapy is significantly dependent on the client’s diagnosis code(s) (ICD-10 codes), procedure code(s) (CPT) billed, and plan restrictions such as in-network/out-of-network providers, etc. The client may also need to obtain additional supportive materials from a referring medical provider such as a prior authorization or a letter of medical necessity (LMN). Music therapy is billed just like all other allied health services using a procedure code for the service provided. The code most generally used for music therapy is G0176 which is “Activity Therapy”. Music therapy may also be submitted to insurance for payment using the following procedure/service codes: CPT Codes for Music Therapy. It is very important to note that codes used by music therapists are often shared with other allied health providers so it is important to know that if services are paid for treatment at LIH, this may limit the number of sessions with another allied health provider.
I contacted my private health insurance plan and I was told that music therapy is not covered. Is this accurate?
Possibly. It may certainly be true if there is no coverage for services that a music therapist would be providing (see CPT Codes for Music Therapy) or if the insurance plan does not allow for services to be provided by an individual with the credential MT-BC (Music Therapist Board Certified). What often happens is that families will contact an insurance plan and simply ask, “Is music therapy covered under my plan?”. What is often misunderstood is that music therapy is the setting in which the individual will work on other procedure codes that would possibly be covered. If a family calls to ask if physical therapy is covered, they will be determining what codes are covered that will take place in a physical therapy setting. There is no specific code that states “physical therapy,” just like there is no specific code that states “music therapy.” Instead, we instruct families to contact your private health insurance carrier to ask if there is coverage for a specific procedure code/CPT code that will be targeted within the music therapy setting. We also instruct families to be sure the insurance representative is aware of the individual’s ICD-10 (diagnosis) code(s) as this often impacts whether or not a procedure/service code is allowable. In addition, it is very important to also ask if there are restrictions on who can provide the service (i.e. credential, in-network/out-of-network, etc.).
I have a Health Savings Account (HSA). Can I use my HSA funds for music therapy?
Yes, depending on your HSA rules/regulations. We have had families successfully submit their receipt/invoice for music therapy services. Please do let us know if the invoice needs to have specific information included such as LIH’s Employer Identification Number (EIN), the assigned therapist’s National Provider Identification (NPI) number, or service code/procedure code (CPT code). We are happy to assist you with what you need to make the best use of these valuable dollars!
How are services billed at LIH?
Just like when you receive a service such as a haircut, massage, or oil change, a fee for the music therapy session/service is due at the time the session/service was completed/received; however, LIH does offer three different methods to pay (and save)! Because we greatly value clients’ commitment to our services, LIH offers a discount for sessions paid in advance by offering a 10% discount for monthly payment plans and 13% discount for per quarter/semester payment plans. Please contact LIH for current pricing information or visit our online store (soon to come)! Payment can be made in the form of cash, credit card, or personal check. LIH does invoice/receive payments after the date of service in special (pre-arranged) situations. This is typically reserved for agencies/organizations where the service must be rendered prior to payment of the services. Additional fees may apply if payment is received following the date of service and this was not pre-arranged.