Notice of Collateral Therapy Age Limit

11/12/2020

Dear Provider and Staff,

WellCare of Kentucky has some important information to share with you regarding benefit coverage for collateral therapy.

Pursuant to the Department for Medicaid Services (DMS) regulations, DMS does not cover collateral therapy for individuals aged twenty-one and above. As stated in Title 907 of the Kentucky Administrative Regulations, collateral therapy “shall not be reimbursable if the therapy is for a recipient who is at least twenty-one (21) years of age.”

DMS defines collateral therapy as a “behavioral health consultation with a parent or caregiver of a recipient, household member of a recipient, legal representative of a recipient, school personnel, treating professional, or other person with custodial control or supervision of the recipient.” DMS currently requires collateral therapy to be billed with CPT code 90887 (other psychiatric services or procedures).

WellCare discovered payments made for this service for individuals twenty-one and older. This notice is to remind you that WellCare will not reimburse for collateral therapy related to an individual who is at least twenty-one and will deny any future claims for this service that exceeds the age limit.

Additionally, if you were erroneously paid for this service, WellCare intends to recover any such payments in accordance with KRS 304.17A-714. We regret any inconvenience this may cause.

If you have any question regarding this notice, please contact your Provider Relations representative.

Sincerely,

WellCare of Kentucky