Master’s Level Therapists as Providers
Master’s Level Therapists (MLTs) are allowed to provide behavioral health interventions and mental health therapy on workers’ compensation claims effective Jan. 1, 2024. MLTs include:
- Licensed independent Clinical Social Workers (LICSWs)
- Licensed Marriage and Family Therapists (LMFTs), and
- Licensed Mental Health Counselors (LMHCs)
MLTs cannot diagnose conditions or act as attending providers.
Behavioral health interventions (BHI) are not mental health counseling and cannot be used on a mental health diagnosis. They’re brief courses of care, addressing psychosocial barriers, normal reactions to an injury, and coping strategies that impede recovery. These treatments use the accepted physical diagnosis and focus on improving workers’ ability to return to work.
The Washington State Department of Labor & Industries (L&I) updated the payment policy for behavioral health interventions, effective Jan. 1, 2024. The policy is applicable to MLTs and psychologists who use behavioral health intervention CPT® codes 96156-96159. All other providers may provide BHI services as part of their evaluation and management service.
Referrals must come from the attending provider; however, any claim party may recommend a worker receive these services. Workers may receive individual interventions, interventions as part of a group setting, or some combination of interventions. See our updated policy for details.
Behavioral Health Services from MLTs or psychologists:
- Require a referral from the attending provider.
- Do not require prior authorization.
- Are a brief course of care, addressing psychosocial barriers that impede recovery and focusing on improving workers’ ability to return to work.
- Utilize CPT© codes 96156, 96158, and 96159 for individual therapy.
- Allow no more than one billable hour on a single date of service/visit.
- Have a maximum of 16 (up to an additional 8 visits with prior authorization) individual visits per claim.
- Have a maximum of 16 visits for group therapy (this is separate from the individual visits per claim).
- Require progress and improvement to be shown in function throughout visits.
BHI Audio: These are services are provided via audio only, by a qualified medical provider, where the provider is unable to perform a visual assessment of the worker.
- Local code 9959M
- Counts toward the limits of up to 16 visit count total for individual therapy (up to an additional eight visits with prior authorization based on progress); audio only is not allowed for group therapy.
- Require additional documentation requirements.
- See chapter 22: Other Services for audio only requirements.
BHI Telehealth: These are face-to-face services delivered by a qualified medical provider through real-time, two-way, audio video connection. These services are not appropriate without a video connection.
- Same services as if in person.
- Same limits as if in person.
- Same documentation as if service is in person; requires notation of worker’s location.
- See chapter 22: Other Services for telehealth requirements.
Mental health therapy MLTs can also provide psychotherapy treatment when a worker has a diagnosed, work-related mental health condition accepted on the claim or as an aid to recovery.
Mental health therapy services from MLTs:
- Require a referral from the attending provider.
- Require a diagnosis from a psychiatrist, psychologist or psychiatric advanced registered nurse practitioner (ARNP).
- Requires prior authorization, see Mental Health Services.
- Require documentation of progress and improvement to be shown in function throughout visits.
For an MLT to become a provider for workers, they must complete a ProviderOne Application (Refer here for details and guides). All providers new to L&I and ProviderOne must apply for an L&I account through ProviderOne.
For questions related to this payment policy, email: HPPM@Lni.Wa.Gov.
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