Date: November 30, 2021
To: All Medical Assistance Program Providers
Re: Coverage of Licensed Clinical Professional Counselors and Licensed Marriage and Family Therapist Services Effective December 1, 2021
This notice informs providers of new coverage per PA 102-0043 of services rendered by Licensed Clinical Professional Counselors (LCPCs) and Licensed Marriage and Family Therapists (LMFTs) enrolled for participation in the Medical Assistance Programs beginning with dates of service on or after December 1, 2021.
LCPCs and LMFTs may receive reimbursement for the delivery of certain diagnostic and therapeutic services provided in the office, home or community setting for the treatment of the customer, consistent with the covered services and reimbursement rates found on the Fee Schedule for Licensed Practitioners of the Healing Arts (LPHAs). Additionally, LCPCs and LMFTs may also receive reimbursement for the delivery of a limited number of community-based mental health services identified in 89 Ill. Admin. Code 140.453. Please refer to the Handbook for Community-Based Behavioral Services (CBS), Section 208.3, Group A services.
HFS is in the process of completing system programming to allow for reimbursement of LCPC and LMFT services. LCPC and LMFT fee-for-service claims with dates of service beginning December 1, 2021 will be held by HFS until programming is completed and then released for processing.
For services rendered to customers enrolled in HealthChoice Illinois, please contact the appropriate Managed Care Health Plan for detailed billing instructions.
Provider Qualifications and Enrollment
Qualified practitioners seeking to enroll with the Department to provide LCPC or LMFT services must enroll in the IMPACT system with the appropriate Provider Type, Specialty, and Subspecialty, as outlined in the table below.
|Behavior Health Services||Licensed Clinical Professional Counseling||No Subspecialty|
|||Licensed Marriage and Family Therapist (LMFT) Services||No Subspecialty|
To enroll as an LCPC, a practitioner must be licensed and legally authorized under State law or rule to practice as an LCPC pursuant to the Professional Counselor and Clinical Professional Counselor Licensing and Practice Act [225 ILCS 107] and implementing rules (68 Ill. Admin. Code 1375). To enroll as an LMFT, a practitioner must be licensed and legally authorized under State law or rule to practice as an LMFT pursuant to the Marriage and Family Therapy Licensing Act [225 ILCS 55] and implementing rules (68 Ill. Admin. Code 1283).
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs