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 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: Over the past years a growing public demand for music therapy services has been accompanied by a demand for third party reimbursement. 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 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.

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

All music therapy services are rendered by qualifying individuals who hold proper accreditations, education and trainings in music therapy.

Minimum qualifications for music therapy service positions at Sounding Joy Music Therapy, Inc. are: Bachelor's degree in music therapy, Board Certification, and at least 2 years of experience in clinical music therapy.

Minimum qualifications for professional training and supervisory positions at Sounding Joy Music Therapy, Inc. are: Master's degree in music therapy, Board Certification, and at least 5 years of experience in the field of music therapy.

Minimum qualifications for music therapy educational positions at Sounding Joy Music Therapy, Inc. are: Master's degree in music therapy or related field with at least 7 years of experience in the field of music therapy.

There are no other counterparts offering music therapy in our community to compare fees. However, The State of Hawaii, Department of Education, currently pays for music therapy as one of the related services under the section Americans with Disability Act (ADA), e.g., physical therapy, occupational therapy, speech therapy, and etc. Our fees may be slightly higher than the national avarage due to the high living-cost in Hawaii. For the consultative services, fees are "considerably higher", a statement made by American Music Therapy Association, who conducts a nationwide research on the subject. Our fees for providing educations & seminars in music therapy are minimum fees provided by State Organization for Professional Training Services.

Price varies for our Music Therapy Direct Services:

• Individual Music Therapy Session
• Group Music Therapy Session
• Music Therapy Consultative Services
• Music Therapy Education & Seminar

Please reach out to us for details.

First of all, there is no other entity offering similar services in our community. Sounding Joy Music Therapy, Inc. is one of the organizations offering human services to the public and the only non-profit organization offering therapeutic services by accredited music therapists in the State of Hawaii. Many music therapy organizations in the United States are non-profit, which is inevitable for the organizations to function and survive, because music therapy is not very popular among people and the society yet.

Sounding Joy Music Therapy, Inc. applies Program Fees: Those are the fees charged for the services rendered to other non-profit organizations or to individuals. Fees are mostly charged to organizations when the organizations requests our services to them or their clients, and the clients are not required to pay.

However, when an individual self-refers to our services, small fees are charged to the individual according to his/her incomes. Please see the sliding fee schedule below:

Sounding Joy Music Therapy, Inc. uses Federal Poverty Guideline for calculating fees for individuals:

Federal Poverty Level | Fee

< 100% | 0%

100 - 150% | 15%

151 - 200% | 30%

201 - 250% | 45%

251 - 300% | 60%

301 - 350% | 75%

351 - 400% | 90%

> 400% | 100%

Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. (American Music Therapy Association, 2005)

Music therapists assess emotional well-being, physical health, social functioning, communication abilities, and cognitive skills through musical responses; design music sessions for individuals and groups based on client needs using music improvisation, receptive music listening, song writing, lyric discussion, music and imagery, music performance, and learning through music; participate in interdisciplinary treatment planning, ongoing evaluation, and follow up.

Persons who complete one of the approved college music therapy curricula (including an internship) are then eligible to sit for the national examination offered by the Certification Board for Music Therapists. Music therapists who successfully complete the independently administered examination hold the music therapist-board certified credential (MT-BC).

The National Music Therapy Registry (NMTR) serves qualified music therapy professionals with the following designations: RMT, CMT, and ACMT. These individuals have met accepted educational and clinical training standards and are qualified to practice music therapy.

American Music Therapy Association (AMTA) promotes a vast amount of research exploring the benefits of music as therapy through publication of the Journal of Music Therapy, Music Therapy Perspectives and other sources. A substantial body of literature exists to support the effectiveness of music therapy worldwide.

That the client or patient has to have some particular music ability to benefit from music therapy -- they do not. That there is one particular style of music that is more therapeutic than all the rest -- this is not the case. All styles of music can be useful in effecting change in a client or patient's life. The individual's preferences, circumstances and need for treatment, and the client or patient's goals help to determine the types of music a music therapist may use.

Music Therapy may includes the use of behavioral, biomedical, developmental, educational, humanistic, adaptive music instruction, and/or other models. Since music therapists serve a wide variety of persons with many different types of needs there is no such thing as an overall typical session. Sessions are designed and music selected based on the individual client's treatment plan.

For inquiries and information, please call Nina Guerrero, Clinical Director, at (808) 593-2620, or email to nguerrero@soundingjoymt.org. Your information is kept absolutely confidential.

All registrants are subject to personal interview before final decisions are made.