Is music therapy reimbursable service? PDF Print E-mail
Music Therapy Reimbursement Facts

Medicare: Since 1994, music therapy has been identified as a reimbursable service under benefits for Partial Hospitalization Programs (PHP).  Falling under the heading of Activity Therapy, the interventions cannot be purely recreational or diversionary in nature and must be individualized and based on goals specified in the treatment plan.  The current HCPCS Code for PHP is G0176.  The music therapy must be considered an active treatment by meeting the following criteria:

  • Be prescribed by a physician;
  • Be reasonable and necessary for the treatment of the individual’s illness or injury;
  • Be goal directed and based on a documented treatment plan;
  • The goal of treatment cannot be to merely maintain current level of functioning; and
  • The individual must exhibit some level of improvement.
Sounding Joy Music Therapy, Inc. has become a Meidcare participating provider since September 2005. When all above mentioned conditions are met by a patient, we now are able to claim payments for music therapy from Medicare.
Medicaid: As Medicaid programs vary from state-to-state, so do the Medicaid coverage avenues for music therapy services.  Some private practice music therapists have successfully applied for Medicaid provider numbers within their states, and Sounding Joy Music Therapy, Inc. has also become a Medicaid participating provider in Hawaii since 2005. Some states, including Hawaii, also offer waiver programs in which music therapy can be covered.  In some situations, although music therapy is not specifically listed as a covered service, due to functional outcomes achieved, music therapy interventions can fall under an existing treatment category such as community support, rehabilitation, or habilitation.

Private Insurance: The number of success stories involving third party reimbursement for the provision of music therapy services continues to grow.  Over the past twelve years a growing public demand for music therapy services has been accompanied by a demand for third party reimbursement.  In response to the increasing demand the music therapy profession has worked to facilitate the reimbursement process for clients of music therapy services.  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.  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.

Other Sources: Additional sources for reimbursement and financing of music therapy services include: many state departments of mental health, state departments of mental retardation/developmental disabilities, state adoption subsidy programs, private auto insurance, employee worker’s compensation, county boards of mental retardation/developmental disabilities, IDEA Part B related services funds, foundations, grants, and private pay.