Behavioral Health

Behavioral health interventions are brief courses of care with a focus on the worker's ability to return to work by addressing psychosocial barriers that impede their recovery.

These psychosocial barriers are not components of a diagnosed mental health condition; instead, they are typically the direct result of an injury, although they can also arise due to other factors. Because they arise from and are related to recovery of a physical injury, they use the physical injury diagnosis of the accepted condition. Common barriers are impaired recovery expectations, catastrophic thinking, and fear avoidance behavior. To learn more, refer to Psychosocial Barriers Influencing Recovery.

Intervention can take many forms. Cognitive behavioral therapy, problem solving therapy, and motivational interviewing are popular methods. For an overview of other common modalities, see https://aims.uw.edu/evidence-based-behavioral-interventions-primary-care.

Behavioral health interventions are appropriate if the provider has reason to believe that psychosocial factors, difficulty coping, or additional barriers may be affecting the worker’s medical treatment and management of an injury, or affecting their return to work efforts.

Billing & Payment Policy

There are several provider types that may offer behavioral health services and each has different requirements and limitations. It is important to note that these services are not a replacement for mental health services. If there is suspected mental health, please refer to our mental health services resource.

Provider Type Prior Authorization? Requirements & Limitations Coverage Policies
Psychologists No
  • Requires AP referral
  • Chapter 22 MARFS
    Master’s Level Therapists (MLTs) No
  •  Requires AP referral
  • Must be participating in L&I’s pilot
  • Limited to 16 visits per claim
  • MLT pilot page
    Attending Provider (AP) No
  • Behavioral health must be bundled with an E/M codes, not billed separately
  • Chapter 10 MARFS

    Note: Behavioral health interventions aren’t covered if a diagnosed mental health condition has been accepted or denied by order on a claim. See Chapter 17 of MARFS for details on treating mental health conditions.

    Resources

    Here are a selection of resources and more information on behavioral health services and how they can influence a worker's recovery: