Licensed Mental Health Counselor


Question posed to me, about to research so thought I'd start here...

We have a provider who is a Licensed Mental Health Counselor. He sees patients in the office and uses codes 90834 and 90837. Apparently Medicare does not credential this type of provider (is that correct??). Is it okay to bill these services under the supervisor (incident-to)? If so, then general supervision is not okay, correct? Meaning the supervisor must be one site. That's what I'm thinking and that's how I'm interpreting this article, just want to be sure.



  • Correct, Medicare does not credential LMHCs. For Medicare patients, their services may be billed incident to a credentialed provider if all incident to criteria are met. Direct supervision must be provided, which means the billing provider must be both "in the office suite," and immediately available to render assistance if necessary.

    As to the proximity requirement of “Direct Supervision,” the fact sheet says "direct supervision" means "within the envelope of the building," but that is not necessarily correct as a building may have 5 floors, each with its own office suite. Your email mentions being "on-site," which again is not quite correct, as this equates to being "on-the-premises," which would include not only the building in which the office suite is located, but the attached property. "Office suite" means just that. They step out of the 3rd-floor office and go to a break room on Floor 1 shared by multiple offices, they are out of the office. The fact that they are still in the same building doesn't matter. They go to the parking lot for a smoke break, they're out of the office, no matter that they remain "on-site."

    The fact sheet (that I saw on my quick read-through) didn’t even mention the second requirement of “Direct Supervision,” the need for the billing physician to be immediately available to render assistance should it be required. This means that the billing provider cannot be engaged in any activity from which he/she could not easily extract him/herself.

    Hope this helped.

    Seth Canterbury, CPC, CPC-I

    Clinical Data Quality Education Department

    University of Florida Jacksonville Physicians, Inc.

    653 West Eighth Street

    Tower I, Suite 606

    Jacksonville, FL 32209

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