Ohio Medicaid psychotherapy coverage: limits and who can bill
The short answerOhio Medicaid pays enrolled licensed psychologists and independent practitioners (LPCC, LISW, LIMFT, LICDC, school psychologist) for 30, 45 and 60 minute psychotherapy, family and group therapy. Services by supervised practitioners (LPC, LSW, LMFT) are paid to a supervising provider. Diagnostic evaluation is limited to one per code per billing provider per calendar year.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Ohio. Public policy, not the member's benefits.
Ohio Medicaid
Ohio Administrative Code rule 5160-8-05, Behavioral health services, other licensed professionals · Ohio
| Where it applies | Covered: psychiatric diagnostic evaluation, psychological and neuropsychological testing, alcohol or substance use structured assessment and intervention, individual psychotherapy of 30, 45 and 60 minutes, crisis psychotherapy, interactive complexity, family psychotherapy with or without the patient when the primary purpose is treating the patient, group and multiple-family group psychotherapy, and prolonged service. [1] |
|---|---|
| Visit limits | Diagnostic evaluation is one encounter per code per billing provider per recipient per calendar year and not on the same date as a therapeutic visit. Psychological testing is 12 hours and neuropsychological testing 8 hours per calendar year. Limits can be exceeded only with prior authorization. [1] |
| Who can bill | Independent practitioners are the licensed professional clinical counselor, licensed independent social worker, licensed independent marriage and family therapist, licensed independent chemical dependency counselor and licensed school psychologist. Supervised practitioners are the LPC, LSW, LMFT and LCDC II and III. Licensed psychologists and independent practitioners must be enrolled in Medicaid; those in independent practice who can participate in Medicare must do so, or if the practice is limited to pediatric treatment, meet all Medicare participation requirements other than serving Medicare beneficiaries. [1] |
| Also | Services by supervised practitioners or supervised trainees under general supervision (supervisor available by phone) are paid to the supervising physician group practice, clinic, community behavioral health center, physician, APRN, PA, or licensed psychologist or independent practitioner in independent practice. Progress notes must record the date, time of day, duration and the time the provider spent with the patient. A treatment plan is due within five sessions or one month, whichever is longer. No payment for family therapy to train family members or caregivers, or for services unrelated to a specific behavioral health diagnosis. [1] |
What Ohio Medicaid's documents say
The table above has every field we found for Ohio Medicaid, with numbered sources. In short:
- Visit limits. Diagnostic evaluation is one encounter per code per billing provider per recipient per calendar year and not on the same date as a therapeutic visit. Psychological testing is 12 hours and neuropsychological testing 8 hours per calendar year. Limits can be exceeded only with prior authorization.
- Who can bill. Independent practitioners are the licensed professional clinical counselor, licensed independent social worker, licensed independent marriage and family therapist, licensed independent chemical dependency counselor and licensed school psychologist. Supervised practitioners are the LPC, LSW, LMFT and LCDC II and III. Licensed psychologists and independent practitioners must be enrolled in Medicaid; those in independent practice who can participate in Medicare must do so, or if the practice is limited to pediatric treatment, meet all Medicare participation requirements other than serving Medicare beneficiaries.
- Where it applies. Covered: psychiatric diagnostic evaluation, psychological and neuropsychological testing, alcohol or substance use structured assessment and intervention, individual psychotherapy of 30, 45 and 60 minutes, crisis psychotherapy, interactive complexity, family psychotherapy with or without the patient when the primary purpose is treating the patient, group and multiple-family group psychotherapy, and prolonged service.
Other psychotherapy rows for Ohio
Check Ohio Medicaid's claim against the row
Before the claim goes out, compare it with the row above: the code matches the session length you documented, the place of service and modifier fit a video or audio-only visit, and the rendering clinician's license is one the payer enrolls. The psychotherapy table compares Medicaid with every other payer we checked.