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Insurance Billing

Pentatonic Therapies will work to verify your existing private insurance benefits to see if music therapy services are covered. Music therapy may be billed using alternative billing codes that fall under existing rehabilitative and therapeutic benefits. Music therapy is considered Out of Network for all plans. In the state of Georgia, businesses have had success in billing with Aetna, Cigna, UHC, and other out of network benefits.

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Medicaid does not cover music therapy services in the state of Georgia.

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According to the American Music Therapy Association

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Is music therapy a reimbursable service?

 
Medicare

"Since 1994, music therapy has been identified as a reimbursable service under benefits for Partial Hospitalization Programs (PHP).  Falling under the heading of Activity Therapy, the interventions cannot be purely recreational or diversionary in nature and must be individualized and based on goals specified in the treatment plan.  The current HCPCS Code for PHP is G0176.

 The music therapy must be considered an active treatment by meeting the following criteria:

  1. Be prescribed by a physician;

  2. Be reasonable and necessary for the treatment of the individual’s illness or injury;

  3. Be goal directed and based on a documented treatment plan;

  4. The goal of treatment cannot be to merely maintain current level of functioning; the individual must exhibit some level of improvement."

 
Private Insurance

"Music therapy is comparable to other allied health professions like occupational therapy and physical therapy in that individual assessments are provided for each client, service must be found reasonable and necessary for the individual’s illness or injury and interventions include a goal-directed documented treatment plan.

Companies like Blue Cross Blue Shield, United Healthcare, Cigna, and Aetna have all paid for music therapy services at some time.  Success has occurred on a case-by-case basis when the therapist implements steps within the reimbursement process. Like other therapies, music therapy is reimbursable when services are pre-approved and deemed medically or behaviorally necessary to reach the individual patient's treatment goals."

 
Other Sources

"Additional sources for reimbursement and financing of music therapy services include: many state departments of mental health, state departments of developmental disabilities, state adoption subsidy programs, private auto insurance, employee worker’s compensation, county boards of developmental disabilities, IDEA Part B related services funds, foundations, grants, and private pay."

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