Behavioral Health Treatment Documentation Requirements

This policy covers documentation requirements for behavioral health treatment services provided to members/enrollees—including Medicaid and Medicare beneficiaries—by appropriately licensed clinicians (e.g., LCSW, LMFT, LP, LPEI, LPC, LADAC, APRN, MD, DO). It requires complete, accurate, and timely encounter notes and discharge summaries, limits coverage to services within the rendering provider’s individual scope of licensure (excluding provisional or unlicensed providers such as CIT, RDS, LAC, LMSW, PLP), and notes that state Medicaid provisions, Medicare NCDs/LCDs, and Centene HIM plan terms take precedence.

"Services provided by a Licensed Clinical Social Worker (LCSW) are acceptable."

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