Does Health Insurance Cover Music Therapy or Counseling in New Hampshire?
If you've ever tried to figure out whether your health insurance will cover therapy services, you already know how complicated it can be. We get this question a lot — and we want to give you a straight answer.
The Sonatina Center is a private-pay practice. That means we do not bill insurance companies directly. However, depending on your plan and your situation, you may be able to get reimbursed for some or all of your services. Here's how it breaks down.
Medicaid
Core Medicaid does not cover music therapy or counseling services at The Sonatina Center. However, if you or your child receives services through a NH Medicaid waiver, that's a different story.
The Sonatina Center is an approved provider with NH DHHS for Medicaid waiver services. NH currently has four Home and Community Based Services (HCBS) waiver programs that may cover music therapy for eligible individuals:
Developmental Disabilities (DD) Waiver
Acquired Brain Disorder (ABD) Waiver
In Home Supports (IHS) Waiver
Choice for Independence (CFI) Waiver
If you think you or your child may be eligible for waiver services, we recommend starting with your county area agency. Area agencies administer waiver programs across NH's ten regions and can help you navigate the application process. You can find your area agency through the NH DHHS website.
Private Insurance — Music Therapy
Music therapists are currently out-of-network providers with all insurance companies in New Hampshire. We do not bill insurance directly, but we can provide you with a superbill that you can submit to your insurance company for potential reimbursement.
Here's what the process looks like:
Call your insurance company first. Ask them three things: Do I have out-of-network benefits? Does my plan exclude music therapy? Does my plan cover CPT code 97530?
Get a referral from your primary care physician. Your PCP will need to provide a referral that includes a diagnosis code. We do not diagnose — that piece needs to come from your doctor.
We provide your superbill. Once we have your PCP referral on file, we can generate a superbill after each session that you submit to your insurance company for reimbursement.
Whether your claim is approved depends on your specific plan. Every insurance company is different, and coverage varies — but it is worth asking.
Private Insurance — Mental Health Counseling
Our licensed mental health counselor is also an out-of-network provider. The same superbill process applies, with one difference: your counselor will assign your diagnosis code and CPT code for psychotherapy as part of the clinical process. You do not need a PCP referral for counseling.
As with music therapy, we recommend calling your insurance company ahead of your first session to ask about your out-of-network benefits.
Still have questions?
We're happy to help you think through your options. Get in touch with us and we'll do our best to point you in the right direction.