April 2025 Top of Mind

Billing update for outpatient services delivered under supervision​

The Virginia Department of Medical Assistance Services has updated its billing and claim submission requirements when outpatient services are delivered under supervision by a Licensed Mental Health Professional (LMHP) to clients covered by a Dual Special Needs Plan (DSNP). DSNP members are eligible for and enrolled in both Medicare and Medicaid.  

Billing Changes 

Effective Jan. 1, 2025, outpatient therapy claims for services rendered under supervision must include the DQ qualifier and the U5 modifier to be eligible for reimbursement.  

In addition, providers no longer need to submit separate claims for Medicare and Medicaid reimbursement. The DSNP will coordinate both the Medicare and Medicaid portions of the claim at once. This streamlines the DSNP billing process, saves time and helps providers get full reimbursement sooner. With this OPptum update, supervising providers no longer need to attach an attestation to claims when a member is seen by a supervisee for mental health therapy.  

For more information, review this Quick Reference Guide, the DMAS announcement and the page 10 of the DMAS provider manual. 

Services rendered under supervision 

Supervised services are generally performed by either unlicensed practitioners (supervisees) who are completing the hours required for initial or full credentialing, or licensed clinicians who are pursuing a higher level of licensure. Claims for these services are submitted by the provider overseeing the clinician who is gaining experience (supervisor).