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RachelF

Anyone know of PA's that are counselors without prescribing?

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Hi fellow PA's. I practiced as a PA about a decade ago. I had children and began investing other interests such as mental health, spirituality and counseling. 

I am now ready to go back to work and I've been thinking about my real love. It's sitting down with patients and really helping them with their lives, their emotional lives, their relationship with themselves and others. Helping them get honest with themselves about their troubles and sincerely find a solution. I guess it's bit like coaching and counseling without prescribing meds. I use a method called Non -Violent communication that really helps patients heal emotional discords.

I was initially going to start all over and get a degree in counseling or social work.  But I have many years of counseling training and am very successful at it in private practice. So going back to school would really just be to satisfy employers. I sincerely feel that I have the skills and much training to be a therapist/counselor. 

My question is does anyone know of PA's who focus on the mental counseling aspect of health without prescribing meds?  I do not want to get into prescribing meds. I have seen countless patients heal through mental healing without the use of drugs.   Am I way off track with this job description, is a PA and prescribing always go together? or  Can you point me in the direction of others already doing what I would like to do?  I want to decide whether to get re-certified as a PA or go back go in an entirely new direction and get a whole new degree as a mental health counselor. Where can I get answers on this?

Thanks!

Rachel

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It is possible to find a job like this, but very rare.  I did outpatient psych and focused on treatment/prescribing.  We had therapists in the practice for counseling.  It just depends on where you are going to work and insurance billing.  Pretty much any practice focused on counseling/mental health will want a provider that is able to bill insurance for their services.  So, you will need a license to do this.  How did you have a "private practice"? I'm not certain of details, but I think if one calls themselves a "life coach" and doesn't deal with insurance by taking cash pay patients only, then it could be possible. 

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Another key issue will be the feasibility of using psychotherapy CPT codes to bill for your services. 

In one of the states in which I hold a PA license, PAs cannot use the CPT codes for conducting therapy at all, as PAs are not considered by the state board to be appropriately trained to engage to deliver this service.  In the second state in which I am licensed as a PA, you must appeal to the licensing board for a special provision and convince them that you have the appropriate additional training (usually defined by the board as a formally earned, mental health degree) to be able to provide, and bill for, psychotherapy services.

My suggestion, then, is to check with your state licensing board to determine the definition a PA's scope of practice with regard to mental health services (if you choose to regain your license and attempt this endeavor under a PA license).  If you are truly doing non-medical treatment, then the medical CPT codes are not applicable.

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There are already enough hackneyed therapists out there who are not using best practice that are are actually trained and licensed to do therapy. The last thing we need are PAs thinking they can competently perform psychotherapy when they have never had didactic or clinical training to do so. For the sake of the people you are trying to help, go back and become an MFT or LCSW.

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Eh, it'd be entirely possible to bill a 99214 on time for a 30 minute counseling visit, as long as you have appropriate H&P to go along with it.  Doing that weekly might pose a problem, but I routinely have a large portion of counseling in monthly visits with certain patients.

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