Psychotherapy FAQs

MO HealthNet covers behavioral health services including psychotherapy/counseling services for mental health conditions and substance use disorders that are provided by licensed mental health professionals. Refer to the Behavioral Health Services Provider Manual for more information.

Precertification

What is the difference between a prior authorization (PA) and a precertification?

There is no difference between a PA and a precertification.  The terms are often used interchangeably. 

Will a precertification of psychotherapy services be based on units, sessions, visits or hours?

A precertification for psychotherapy services is based on hours. Refer to Section 1.5 of the Behavioral Health Services Provider Manual for more information.

When is a precertification required and how does a provider request precertification for psychotherapy?

Individual, group, and family therapy services (beyond the first 14 hours) provided to participants age three or older) must be precertified. With the exception of diagnostic evaluation, precertification is required for all covered services (i.e., psychological testing and family therapy) provided to children age birth through two years. See Section 1.10 of the Behavioral Health Services Provider Manual for procedure codes and modifiers.

The first precertification requested by the provider is the initial authorization and any services requested after this are considered continued treatment. A precertification request for continued treatment must be accompanied by the current/updated Diagnostic Assessment, current/updated Treatment Plan and the last three progress notes for the therapy being requested. Online submission of required documentation is not currently available.

To request precertification the provider or designated staff may make the request online through CyberAccess, by fax, mail, or via telephone.

                  MO HealthNet Division

                   PO Box 4800

                  Jefferson City, MO 65102

After submitting, how does a provider know if a precertification is approved or denied?

Telephone requests made by calling the Behavioral Health Services Help Desk at (866) 771-3350 will receive a verbal denial, or an approval and a precertification number at the time of the call. No written approval is provided for a precertification requested by telephone. Providers are required to maintain this precertification in the patient’s record and provide to MHD upon request.

For precertification requests submitted via fax to (573) 635-6516 or mail, a response will be faxed back to the provider when possible or will otherwise be mailed.

What if additional information is needed when requesting a precertification?

If additional information is needed when requesting a precertification by phone, the precertification will not be approved and the caller will be instructed to fax or mail the Behavioral Health Services Request for Precertification form and required documentation.

What is the precertification process when a patient has private insurance or Medicare and MO HealthNet coverage?

If a patient has private insurance a precertification will still be required. Original Medicare is not considered third party insurance; however, if Medicare does not cover the service, a precertification is required for payment by MO HealthNet. Also, Medicare  Advantage  Plans (Medicare  Part  C)  are  considered third  party  insurance, and  precertification  is required  for  non-Qualified Medicare  Beneficiary (QMB)  participants. Services for QMB participants with a Medicare Advantage Plan do not require precertification.

How many hours of psychotherapy services are available once a precertification is approved? How long does the patient have to use the approved hours?

The number of hours precertified is based on the patient’s age, diagnosis, type of therapy and Medical Eligibility (ME) code. Refer to the Behavioral Health Services Provider Manual, Section 1.8 for hours issued for adults (age 21 and over) and Section 1.9 for hours issued for children (ages 0 through 20 and ME code 38 ages 21 through 25). The default precertification is 12 months.

If there are hours remaining on the initial precertification and the patient returns to treatment with the same provider within 12 months, the provider may access the remaining hours however, it is the provider’s responsibility to confirm the availability of those hours remaining.

For a list of ME codes and their descriptions, refer to Section 1 of the General Sections Provider Manual. 

Does psychotherapy for a crisis require a precertification?

Crisis intervention is nonscheduled face-to-face contact to resolve a situation of immediate crisis. The presenting problem is typically life threatening or complex and requires immediate attention to a participant in high distress. Crisis intervention does not require precertification and may be billed by an enrolled provider.

Refer to Section 1.6 of the Behavioral Health Services Provider Manual for additional information on psychotherapy for crisis. 

How does a provider close or change a precertification?

To close or change a precertification, a provider may:

  • Call the Behavioral Health Services Help Desk at (866) 771-3350
  • Send a fax to (573) 635-6516
  • Mail the request to:

MO HealthNet Division
PO Box 4800
Jefferson City, MO 65102

If a participant is changing providers when a precertification is still active, what does a provider need to do? 

If a participant is changing providers, the provider listed on the current precertification must end that precertification before the new provider can obtain a precertification.

To end the precertification, a provider may:

  • Call the Behavioral Health Services Help Desk at (866) 771-3350
  • Send a fax to (573) 635-6516
  • Mail the request to:

MO HealthNet Division
PO Box 4800
Jefferson City, MO 65102

When a participant changes providers, any available units may be transferred from the closed precertification to the new provider’s approved precertification. The new provider does not receive an additional allotment of therapy hours, but rather the portion of therapy hours remaining for the current precertification period. 

What does a provider do if a participant is changing providers and the former provider has not ended their precertification?

The new provider must submit a signed letter from the participant, or participant’s guardian, requesting a change in provider. The signed release must include the participant’s name, DCN, type of therapy to be closed, the number of hours used, and the name of the therapist whose authorization is to be closed. 

 

The signed release should be submitted in one of the following ways:

  • Call the Behavioral Health Services Help Desk at (866) 771-3350
  • Send the release by fax to (573) 635-6516
  • Mail the release to:

MO HealthNet Division
PO Box 4800
Jefferson City, MO 65102

Can a psychologist with an approved precertification refer the patient to another psychologist for objective testing

Yes, the patient may be referred to another psychologist. However, if it is for a child under the age of three, a precertification request and clinical justification must be submitted for approval.

This document must be submitted in one of the following ways:
 

  • Call the Behavioral Health Services Help Desk at (866) 771-3350
  • Send the release by fax to (573) 635-6516
  • Mail the release to:

MO HealthNet Division
PO Box 4800
Jefferson City, MO 65102

When requesting a precertification, along with the Treatment Plan and Progress Notes, do providers submit the original diagnostic assessment or the most recently updated assessment?

Providers should submit the current assessment that is most pertinent to the Treatment Plan and Progress Notes being submitted at the time.

Providers should update the diagnostic assessment annually for adults and adolescents (age 13 to 20) or within six months for children under 13.

Refer to Section 1.3 of the Behavioral Health Services Provider Manual for more information on the diagnostic assessment.

 

Services

How many patients are allowed in Group Therapy?

Group therapy (procedure code 90853) must consist of at least two but no more than 10 individuals who are not members of the same family. This applies to inpatient group therapy sessions also.

Refer to Section 1.6 of the Behavioral Health Services Provider Manual for more information on Group Therapy.

What is MO HealthNet Family Therapy and how is it billed?

Family therapy is defined as the treatment of family members as a family unit, rather than as individual patients. A family may be defined as biological, foster, adoptive or other family configuration. At least 75% of the session must have both child/children and parent(s) present.

When family therapy without the patient present (procedure code 90846) or family therapy with the patient present (procedure code 90847) is provided, the session is billed as one service (one family unit), regardless of the number of individuals present at the session. Providers may not bill family therapy for each family member. Parental issues may not be billed and family  therapy  is only  billable  when defined  in  the treatment  plan  as necessary  on  behalf of  the  identified patient.

Only one precertification per household is approved and open at a time for family therapy. If there is more than one eligible child and no child is exclusively identified as the primary patient, then the oldest  child’s Departmental  Client  Number (DCN)  must  be used  for  precertification  and billing  purposes. When a specific child is identified as the primary patient, that child’s DCN must be used for precertification and billing purposes. Providers should not request more than one family therapy precertification per household, unless submitting a clinical exception request with justification as to why separate treatment is needed.

 

Billing

If MHD denies an authorization, but the patient wishes to continue to be seen, can the patient be billed the full fee?

If the precertification is denied, the patient may be billed only if they have signed an agreement with the provider prior to services being rendered indicating that they will be responsible for payment for specific dates of service and procedures if not covered by their MO HealthNet coverage. The provider should complete and follow-through with all requests for information in the precertification process to assure payment as appropriate.

What modifiers should be used for Psychotherapy billing?

Psychiatrists and advanced practice nurses should utilize either the appropriate Evaluation and Management (E & M) code or the appropriate psychotherapy code listed below. The billing of a combination of psychotherapy and E & M code for a single date of service by the same billing or performing provider is not allowed. Psychiatrists bill with no modifier when billing psychotherapy codes.

The U8 Modifier should be used for services billed with place of service 12 (home). The appropriate modifiers must be used for all codes. The procedure codes and modifiers are listed by provider type below:

Modifier

Provider Type

AH

Psychologist, Provisional Licensed Psychologist

AJ

Licensed Clinical Social Worker, Licensed Master Social Worker

UD

Licensed Professional Counselor, Provisional Licensed Professional Counselor

HE

Licensed Marital and Family Therapist, Provisional Licensed Marital and Family Therapist

SA

Psychiatric Advanced Practice Registered Nurse

Refer to Section 1.20 in the Behavioral Health Services Provider Manual for more information.

What modifiers should be used for Applied Behavioral Analysis (ABA) billing

Providers must use the appropriate modifier(s) when billing ABA services in order to ensure correct reimbursement.

The HO modifier must be included when billing claims for Behavior Analysts and Psychologists. Psychologists should not use the AH modifier when billing ABA procedure codes.

The HN modifier must be included when billing claims for Assistant Behavior Analysts.

Services provided by Registered Behavior Technicians RBT) must use the modifier HM along with the appropriate modifier for the supervisor (i.e., HO for Behavior Analyst or Psychologist; HN for Assistant Behavior Analyst).

The U8 modifier should be used for services billed with a Place of Service 12 (home) or 99 (other). Do NOT use the U8 modifier when billing for services provided by an RBT.

Refer to Section 1.15 in the Behavioral Health Services Provider Manual for more information

Why would a claim deny indicating the patient is not eligible if a precertification was approved for the dates of service?

MO HealthNet participant eligibility can change at any time.  An approved precertification does not guarantee payment as MHD cannot pay for services when a patient is no longer eligible. Precertification approval means the services were deemed to be medically necessary, but the patient must be MO HealthNet eligible on the date of service.  MO HealthNet encourages all providers to check eligibility prior to providing services to participants. 

How do I know how many units should be billed for counseling/psychotherapy services?

MO HealthNet has adopted standard unit definitions per the Current Procedural Technology (CPT) manual. A description of the codes and unit limits may be found in Section 1.10 of the Behavioral Health Services Manual.

Revised October 2024