We hope this page provides answers to the most frequently asked questions (FAQs) we receive about funding for music therapy services at LIH.
What forms of payment are accepted?
LIH accepts cash, personal check, credit card*, HSA card*, and other direct payment methods from third-party payers (i.e. Medicaid waivers, fiscal agents, private grants, and other contracted programs). At this time, music therapy cannot be billed directly to MA. When authorized, music therapy may be billable to an MA waiver and other state program. For information regarding private health insurance claim submission, see below. *A 3% fee may be applied per card transaction
How are services invoiced?
This depends on who the primary payer is for the service. If services are authorized and paid through a third-party payer program such as a waiver, LIH handles all invoicing and payments directly with the program. These services are billed and paid for after the time of service. If services are paid for with private funds (self-pay or private grant), the invoice/receipt of payment will be sent directly to the client/individual responsible for payment via email. Self-pay services are invoiced and paid per service date, unless a monthly pre-paid service plan is requested. For our current fee schedule, please contact email@example.com.
I am currently eligible for Medicaid services within my state. How do I know if LIH can provide services through the programs for which I am currently enrolled?
Our agency is familiar with several third-party payer programs that serve eligible individual living in Wisconsin and Minnesota. As a result, our team has the opportunity to works directly with many social workers, service facilitators, case managers, program consultants, and other individuals who assist with service coordination within each unique program. We invite you to contact your assigned case manager and together you can determine if music therapy is appropriate based on the needs of your service plan. If so, they can help you get connected with our services or another provider. If LIH is not currently a vendor within your current program/county, please connect us with a contact person from your program and can then inquire about vendor/provider requirements and enrollment. The best place to begin is with the care team of the individual who may be in need of services. Our agency is familiar working within several programs.
***enrollment in one of these programs is not a guarantee that music therapy services will authorized
- Children’s Long-Term Support (CLTS) Waiver
- Children’s Community Options Program (CCOP)
- Family Care (FAMC)
- Comprehensive Community Services (CCS) Program
- Consumer Directed Community Supports (CDCS) Program (MN)
- Consumer Support Grants (MN)
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 provide support to individuals who may not have additional funding sources through private or public health coverage. We encourage you to explore these excellent resources and inquiry with the organization about the grant application process or requirements. In the event you receive a grant award, we can discuss treatment plan options and and ideas to maximize the life of the grant if you wish to also cost-share using family funds.
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 or HCPCS) 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. G0176 is the procedure code used to specify “Activity Therapy: Music Therapy.” When appropriate, music therapy may be submitted to insurance using procedure/service codes (CPT codes for music therapy). It is very important to note that codes used by music therapists may be shared with other allied health providers. If services are paid for treatment at LIH, this may limit the number of sessions with another allied health provider. We strongly encourage that you have an open conversation with all therapy providers about your desire to submit claims to your insurance to allow all providers to coordinate care if necessary. If you wish to inquiry about insurance coverage for music therapy services, we recommend that you contact your health plan directly to ask the following questions:
- Does my diagnosis of ______ (ICD-10 Code) allow coverage for ______ procedure code? (G0176 or other)
- Does my plan offer coverage for services provided by a Board Certified Music Therapist (MT-BC)?
- Are there restrictions on out-of-network services? Any specific out-of-network deductibles to note?
- At this time, LIH is an out-of-network provider for all insurance companies.
I have a Health Savings Account (HSA). Can I use my HSA funds for music therapy?
Yes, but we encourage you to review the policy for your account. If you plan to utilize your HSA for music therapy services you will pay for the service with private funds and submit your receipt for reimbursement or you will pay using the HSA card (additional fees may apply for card transactions). If a “super bill” is required, please plan to pay per date of service as pre-payment receipts do not include the date of service.
*Please note that a good faith estimate (GFE) for services is always available upon request*