Music Therapy
Reimbursement
Sources and Steps to Success
AMTA E-course
Judy Simpson, MHP, MT-BC
Discussion Outline
Please read this important note:
This Word document of the discussion outline of Chapters 1 – 11
allows participants to take notes if they choose to do so
while listening to the audio discussion, a key element
of this e-course. This outline is only a portion of the e-course.
Please check the e-course workbook for important information
and supplementary materials in the introductory pages and in
chapters 14 &15 of the Reimbursement e-course workbook
It is important to note this is copyrighted material.
It is unethical and illegal to share with others in any format.
Anyone wanting to order a copy of this AMTA E-course
may check for details here:
Questions? Send us an email <>
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 1
Reimbursement Sources:
Medicare
Listen to the audio segment for Chapter 1.
Discussion Outline
1. Partial Hospitalization (PHP)
A. Healthcare Common Procedure Coding System (HCPCS)
B. Activity Therapy Code: G0176
2. Prospective Payment System (PPS)
A. In-Patient Rehabilitation & Psychiatry
B. Hospice
C. Skilled Nursing Facilities (SNFs)
3. Minimum Data Set (MDS)
A. Restorative Care
B. Section O: Special Treatments,Programs, And Procedures O0400: Therapies
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 2
Reimbursement Sources:
Medicaid
Listen to the audio segment for Chapter 2.
Discussion Outline
1. Approved Providers
2. Waiver Programs
A. Home and Community-Based Care
B. Rehabilitation/Habilitation
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 3
Reimbursement Sources:
Private Insurance
Listen to the audio segment for Chapter 3.
Discussion Outline
1. Indemnity
2. Preferred Provider Organization (PPO)
3. Health Maintenance Organization (HMO)
4. Point of Service (POS)
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 4
Other Reimbursement Sources
Listen to the audio segment for Chapter 4.
Discussion Outline
1. Workers’ Compensation
2. TRICARE
3. Automobile Insurance
4. Adoption Subsidy
5. State and County Boards/Departments
A. Health
B. Social Services
C. Developmental Disabilities
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 5
Reimbursement Terminology
Part 1
Listen to the audio segment for Chapter 5.
Discussion Outline
1. Active Treatment
A. Criteria One
B. Criteria Two
C. Criteria Three
2. Allowable Charge
3. Balance Billing
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 6
Reimbursement Terminology
Part 2
Listen to the audio segment for Chapter 6.
Discussion Outline
4. Billable Charge
5. Billing Forms
6. Carve-Out
7. Case Management
8. Cost Benefit Analysis
9. Credentialing
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 7
Reimbursement Terminology
Part 3
Listen to the audio segment for Chapter 7.
Discussion Outline
1. Diagnostic Codes
A. CD 9-CM
B. ICD 10-CM/PCS
2. Fiscal Intermediary/Carrier
3. Health Insurance Portability and Accountability Act (HIPAA)
4. Negotiated Fees
5. Network Providers
2012, American Music Therapy Association, Inc.
6. National Provider Identifier
7. Per Diem Rate
8. Pre-authorization
9. Procedural Coding
A. CPT 2012
B. HCPCS
10. Revenue Codes
11. Usual, Customary, and Reasonable Fees (UCR)
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 8
Reimbursement Action Plan
Steps 1 through 4
Listen to the audio segment for Chapter 8.
Discussion Outline
1. Step One: Obtain National Provider Identifier Number (NPI)
2. Step Two: Seek Referrals
3. Step Three: Collect Insurance Information
4. Step Four: Determine Client Needs
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 9
Reimbursement Action Plan
Steps 5 through 8
Listen to the audio segment for Chapter 9.
Discussion Outline
Step Five: Prepare Marketing Materials
Step Six: Contact Primary Care Physician
Step Seven: Select Procedure Codes that Best Describe Music Therapy Interventions
Step Eight: Call Insurance Company
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 10
Reimbursement Action Plan
Steps 9 through 12
Listen to the audio segment for Chapter 10.
Discussion Outline
Step Nine: Provide Music Therapy Interventions
Step Ten: Complete Claim Forms
Step Eleven: Submit Claim
Step Twelve: Follow-up with Payer
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 11
Tools for Marketing and Advocacy
Listen to the audio segment for Chapter 11.
Discussion Outline
1. Marketing Tools
2. The Three “Rs”
A. Reimbursement
B. Research
C. Recognition
3. Reimbursement Tips
4. Resources
2012, American Music Therapy Association, Inc.
Music Therapy
Reimbursement
Sources and Steps to Success
Chapter 12
Final Word
Understanding the reimbursement process is an important part of music therapy clinical practice. Our knowledge base of funding options continues to grow as more clinicians seek third-party coverage for medically and/or behaviorally necessary treatments. Although implementing the recommended steps outlined in this e-course may seem overwhelming at first, your efforts will contribute to expanded reimbursement success, and ultimately, increased access to music therapy services.
Our focus on reimbursement is an important example of how AMTA members work together to address goals that are a part of the Association’s Strategic Plan. Specifically, AMTA Strategic Plan, Goal II under Advocacy Section 2.3 states:“Develop strategies that will support the development of legislation, regulations, policies, and programs that will increase access to and funding for music therapy services and programs.”A primary goal for reimbursement and financing related to this AMTA Strategic Plan section was identified in 2001:“Increase access to music therapy services by increasing the percentage of music therapy services receiving reimbursement.”
We recognize that not all music therapy services will qualify for third party coverage, but in clinical settings and with individual cases where interventions meet active treatment criteria, it is essential that clinicians have the knowledge and skills to pursue all reimbursement options available. To assist with this need, AMTA actively implements a Reimbursement Operational Plan, which defines outcomes for music therapists, insurance companies, service providers, and consumers. Your participation in this E-Course helps to fulfill the first outcome: “Music therapists have basic knowledge of the process of reimbursement and financing for music therapy services.”
Experience has shown that as more music therapists attempt to seek reimbursement, more music therapists have success with the process. In order for AMTA to reach the goal of increasing the percentage of music therapy services receiving reimbursement, we need to know not only what steps are working, but also what steps are not working as you engage in this aspect of the healthcare industry. By sharing positive feedback you receive as well as any obstacles you encounter, you will contribute to future reimbursement success for the profession.
Connect with your AMTA Reimbursement Committee Regional Representative for assistance with questions and to let them know the details of your experiences with the process. You can find email addresses for the representative from you region by clicking “Find a Music Therapist” on the AMTA website
2012, American Music Therapy Association, Inc.
The list of current AMTA Reimbursement Committee Regional Representatives is found here:
AMTA members seeking additional reimbursement support may contact National Office staff through email or by scheduling a phone consultation to discuss specific questions and challenges.
Judy Simpson, AMTA Director of Government Relations,
Rebecca Smith, AMTA Government Relations Associate,
Congratulations for completing this AMTA Reimbursement E-course. As you begin to apply this new knowledge you have gained to your music therapy work and your unique clinical setting and clients, we encourage you to report your challenges as well as your success stories. Keep track of the specific funding source, diagnoses, procedure codes, and documentation required to file claims. If coverage is denied, please note reasons cited by the third-party payer and whether or not additional information was provided to appeal the claim. The Supplementary Resources described in Chapter 13 and on the E-course Landing Page have valuable tools, including forms for tracking reimbursement, to assist you throughout your career as a music therapist. Best wishes on your endeavors.
Important Note: This Discussion Outline is only a portion of the AMTA E-course, “Music Therapy Reimbursement” by Judy Simpson, MHP, MT-BC. This Word document is provided to individuals who purchased the Reimbursement E-course to allow for taking notes if they choose to do so while listening to the audio discussion, a key element of this AMTA E-course.
Please check the e-course workbook for important information and supplementary materials in the introductory pages and in chapters 14 and 15 of the workbook for the Reimbursement e-course. Please note this is copyrighted material. It is unethical and illegal to share with others in any format.
Anyone wanting to order their own copy of this AMTA E-course may check for details here:
Questions? Send us an email <>
2012, American Music Therapy Association, Inc.
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