Committee hears testimony on making play therapy a separate Medicaid service

The House Human Services Committee took testimony on "An act relating to Medicaid coverage for play therapy" (age 58), hearing from a clinical graduate student and a longtime child psychologist about whether play therapy should be recognized and billed separately under Medicaid.

Committee members said the bill would ask whether play therapy should be a stand-alone, billable Medicaid service rather than remain an element within the broader psychotherapy benefit. That question matters for clinical practice, documentation and reimbursement for children served by Medicaid.

Christina Snook, a clinical mental health graduate student at Vermont State University, told the committee she has worked more than 20 years in public schools and is studying play therapy. "Play therapy gets a bad rap because of the nature of the word play. We think it's an unstructured thing," she said, adding that "it is children's language" and "a therapist who's fluent in this language, can provide effective evidence based support to children in our state who are served by Medicaid." She said play therapy can treat children experiencing trauma, parental separation and divorce, homelessness and parental substance use disorder, and argued it expands access to children who cannot pay out of pocket.

Dr. Bob Hemmer, a psychologist in private practice in Manchester who treats children and adolescents, described how play-based techniques help establish a therapeutic relationship and permit assessment and treatment for young children who lack the language for traditional talk therapies. He described using Legos, games such as Trouble and adapted activities to teach turn-taking, pacing and coping skills and said those activities are intentionally deployed as therapeutic interventions. "The idea is to engage the child at their level, through play and a playful interaction, to gain some more knowledge about what's going on in their lives and to... establish a relationship so the child starts feeling comfortable," Hemmer said.

Both witnesses told the committee that in practice play therapy is currently provided as part of psychotherapy benefits under Vermont Medicaid. Hemmer described billing psychotherapy under conventional CPT psychotherapy codes (for example, he said he uses 90837 for longer sessions and 90834 for shorter sessions) rather than a separate code for "play therapy." He said, "I don't know of a special code for play therapy, and I've never ever used one in about 25 years."

Committee members asked about consequences of creating a separate, standalone service. Hemmer cautioned that separate coverage could create credentialing or retraining requirements and additional paperwork. "If you say play therapy is a separate component, then they'd say, well, doctor Hemmer, where's your play therapy certificate," he said, warning that separate billing might require distinct documentation or credentials even for clinicians who already provide play-based psychotherapy.

Snook said she has heard of providers who were audited after writing "play therapy" in notes and were not reimbursed; she characterized the current practice as "do it, but don't say you're doing it" when providers include play-based work within psychotherapy billing. "I do know of cases where people have been audited for it and not reimbursed through Medicaid," she told the committee, calling that experience a reason to consider standalone coverage so clinicians could document play therapy explicitly without risking claim denials.

Witnesses and committee members discussed training distinctions among related professions. Hemmer noted art therapy and music therapy involve different training paths and that a licensed psychotherapist can use art as part of psychotherapy, while an art therapist has a different credentialing route. Both witnesses emphasized that play-based methods are clinically targeted, not merely unstructured recreation: Snook said play therapy can be used to target emotion regulation, vocabulary and coping skills with carefully chosen, clinically appropriate toys and activities.

Committee members raised the Department for Vermont Health Access (DVHA) practice; witnesses said DVHA has treated play therapy as an allowable element of psychotherapy but has not provided a separate billing code. The committee did not vote on the bill at the hearing and members asked staff and agencies for more information before formal action.

The testimony highlighted two practical tensions for lawmakers: supporters said separate coverage could make play therapy visible and accessible to Medicaid-enrolled children, while opponents or cautious voices warned a separate line item could require added credentialing and duplicate documentation that offers limited programmatic gain.

The committee concluded the hearing portion and thanked the witnesses for testimony; members said they would seek additional information from relevant agencies before considering statutory language on separate coverage.