Music therapy can be funded many ways – through Medicaid waivers, grants, private insurance reimbursement, and private payment.
The Texas Department of Aging and Disability Services (DADS) currently offers state-funded services to assist people with disabilities. To learn more about the interest lists and how to obtain services for your self or loved one, please visit this link. Music therapy is funded under “specialized therapy” services of the Community Living Assistance and Support Services (CLASS) Medicaid waiver, as well as the In-Home and Family Support (IHFS) grant. We also serve clients on the Youth Empowerment Services (YES) waiver.
At this time traditional Medicaid and Medicare do not cover music therapy services.
Insurance companies are recognizing the advantages of including music therapy as a benefit as they respond to the increasing market demand for greater patient choice of health care services. Companies like, Blue Cross/Blue Shield, Humana, Great West Life, Aetna, Metropolitan, and Provident have reimbursed for music therapy services on a case-by-case basis, based on medical necessity. Music therapy is comparable to other 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. Like other therapies, music therapy is typically pre-approved for coverage or reimbursement, and is found to be reimbursable when deemed medically necessary to reach the treatment goals of the individual patient. Therefore, reimbursement for services is determined on a case-by-case basis and is available in a large variety of health care settings, with patients with varying diagnoses (Certification Board for Music Therapists, 2012).
The American Music Therapy Association now estimates that at least 20% of music therapists receive third party reimbursement for the services they provide. This number is expected to increase exponentially as music therapy occupies a strong position in the health care industry (American Music Therapy Association, 2012).
Heart and Harmony Music Therapy is considered an out-of-network provider for private insurance companies and services may count toward out-of-pocket deductibles. We have an NPI (National Provider Identifier) number and are happy to help you file for private insurance reimbursement by providing an official assessment report, treatment plan, and appropriate CPT codes.
We also accept private payment for our services.
Please schedule a free one hour phone consultation to discuss your payment options.