1. Demographics 1. Please indicate your gender j k l m n
j k l m n
Male
Female
2. Please indicate your age by choosing one of the following age ranges j k l m n
Under 20
j k l m n
20-29
j k l m n
j k l m n
30-39
j k l m n
40-49
j k l m n
50-59
60-69
j k l m n
70 and over
3. Please indicate your current level of certification/training in Music Therapy (check all that apply). c d e f g
Music Therapist-Board Certified
c d e f g
NMT Academy member
c d e f g
NMT Fellow
4. Please indicate your highest level of educational training j k l m n
undergraduate
j k l m n
j k l m n
master’s
PhD
5. Did you purchase the Medical Coding and Records Manual? j k l m n
j k l m n
Yes
No
6. Do you have your National Provider Identifier (NPI) number? j k l m n
j k l m n
Yes
No
7. Choose the job title that best describes your current position (Please check only one). j k l m n
Activity Coordinator/Director
j k l m n
Director/Admin/Supervisor
j k l m n
Other
j k l m n
Activity Therapist
j k l m n
Expressive Arts Therapist
j k l m n
QMRP
j k l m n
Adjunctive Therapist
j k l m n
Faculty
j k l m n
Recreation Therapist
j k l m n
Case Manager
j k l m n
Music Educator
j k l m n
Rehabilitation Therapist
j k l m n
Clinical Therapist
j k l m n
Music Specialist
j k l m n
Self Employed
j k l m n
Creative Arts Therapist
j k l m n
Music Therapist
j k l m n
Special Educator
8. In what state are you employed? (Please check only one) j k l m n
Alabama
j k l m n
Louisiana
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Ohio
j k l m n
Alaska
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Maine
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Oklahoma
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Arizona
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Maryland
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Oregon
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Arkansas
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Massachusetts
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Pennsylvania
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California
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Michigan
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Rhode Island
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Colorado
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Minnesota
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South Carolina
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Connecticut
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Mississippi
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South Dakota
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Delaware
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Missouri
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Tennessee
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Florida
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Montana
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Texas
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Georgia
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Nebraska
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Utah
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Hawaii
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Nevada
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Vermont
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Idaho
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New Hampshire
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Virginia
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Illinois
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New Jersey
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Washington
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Indiana
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New Mexico
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West Virginia
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Iowa
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New York
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Wisconsin
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Kansas
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North Carolina
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Wyoming
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Kentucky
j k l m n
North Dakota
9. Please indicate all places of employment where you have attempted reimbursement.(Please check all that apply) c d e f g
Adult Day Care
c d e f g
General Hospital
c d e f g
Outpatient Clinic
c d e f g
Adult Education
c d e f g
Geriatric Facility - not nursing
c d e f g
Partial Hospitalization
c d e f g
Child/Adolescent Treatment Ctr.
c d e f g
Geriatric Psychiatric Unit
c d e f g
Physical Rehabilitation
c d e f g
Children's Day Care/Preschool
c d e f g
Group Home
c d e f g
Private Music Therapy Agency
c d e f g
Children's Hospital or Unit
c d e f g
Home Health Agency
c d e f g
School (K-12)
c d e f g
Community Based Service
c d e f g
Hospice/Bereavement Services
c d e f g
Self Employed/Private Practice
c d e f g
Community Mental Health Center
c d e f g
ICF/MR
c d e f g
State Institution (not ICF/MR)
c d e f g
Correctional Facility
c d e f g
Inpatient Psychiatric Unit
c d e f g
Support Groups
c d e f g
Day Care/Treatment Center
c d e f g
Music Retailer
c d e f g
University/College
c d e f g
Drug/Alcohol Program
c d e f g
Nursing Home/Assisted Living
c d e f g
Veteran's Affairs
c d e f g
Early Intervention Program
c d e f g
Oncology
c d e f g
Wellness Program/Center
c d e f g
Forensic Facility
c d e f g
Other
10. If you answered "other" to question 9, please indicate what setting.
11. Please indicate which clients you most frequently provide services to. (Check all that apply) c d e f g
Alzheimer's/Dementia
c d e f g
Autism
c d e f g
Language and Speech Impairments Medical Conditions (Burn, Cancer
c d e f g
Sensory Disorders
c d e f g
Stroke
c d e f g
c d e f g
Behavioral Disorder
c d e f g
Cerebral Palsy
c d e f g
Developmental Disabilities (Mental Retardation)
etc)
c d e f g
Traumatic Brain Injury
c d e f g
Mental Disorders
c d e f g
University Students without
c d e f g
Multiple Sclerosis
c d e f g
c d e f g
Other
Parkinsons
Disorders
12. How long (in years) have you been applying NMT in your practice? j k l m n
j k l m n
1-5 years
6-10 years
13. How long (in years) have you been in practice altogether, including your current position and previous employment? j k l m n
1-5 years
j k l m n
6-10 years
j k l m n
11-15 years
j k l m n
16-20 years
j k l m n
j k l m n
21-25 years
26-30 years
j k l m n
more than 30 years
14. Please specify your annual gross income for services (round to the nearest thousand). j k l m n
Less than $10,000
j k l m n
$41,000 - $45,000
j k l m n
$76,000 - $80,000
j k l m n
$11,000 - $15,000
j k l m n
$46,000 - $50,000
j k l m n
$81,000 - $85,000
j k l m n
$16,000 - $20,000
j k l m n
$51,000 - $55,000
j k l m n
$86,000 - $90,000
j k l m n
$21,000 - $25,000
j k l m n
$56,000 - $60,000
j k l m n
$91,000 - $95,000
j k l m n
$26,000 - $30,000
j k l m n
$61,000 - $65,000
j k l m n
$96,000 - $100,000
j k l m n
$31,000 - $35,000
j k l m n
$66,000 - $70,000
j k l m n
$101,000 and over
j k l m n
$36,000 - $40,000
j k l m n
$71,000 - $75,000
2. Funding for Neurologic Music Therapy Services 1999-2000 15. For the years 1999-2000, please indicate how your services were funded. (Check all that apply) c d e f g
Group/Private Insurance
c d e f g
Private Pay
c d e f g
Other
c d e f g
Medicare
c d e f g
Grants/Endowments
c d e f g
Not in clinical practice at that time
c d e f g
Medicaid
c d e f g
Financed by Facility
c d e f g
Tricare
c d e f g
Government Funds
16. For the years 1999-2000, please indicate by domain the number of clients you were successfully reimbursed for by Medicare, Medicaid, Tricare, Private Insurance or other government funds. (If this does not apply, please skip to the next question) Sensorimotor techniques Cognitive techniques Speech and Language techniques
17. If you did not answer the previous question, please indicate why you did not achieve successful reimbursement during the years 1999-2000. j k l m n
Did not attempt reimbursement during this time.
j k l m n
Attempted but was not successful in getting reimbursement during this time.
3. Funding for Neurologic Music Therapy Services 2001-2002 18. For the years 2001-2002, please indicate how your services were funded. (Check all that apply) c d e f g
Group/Private Insurance
c d e f g
Private Pay
c d e f g
Other
c d e f g
Medicare
c d e f g
Grants/Endowments
c d e f g
Not in clinical practice at that time
c d e f g
Medicaid
c d e f g
Financed by Facility
c d e f g
Tricare
c d e f g
Government Funds
19. For the years 2001-2002, please indicate by domain the number of clients you were successfully reimbursed for by Medicare, Medicaid, Tricare, Private Insurance or other government funds. (If this does not apply, please skip to the next question) Sensorimotor techniques Cognitive techniques Speech and Language techniques
20. If you did not answer the previous question, please indicate why you did not achieve successful reimbursement during the years 2001-2002. j k l m n
Did not attempt reimbursement during this time.
j k l m n
Attempted but was not successful in getting reimbursement during this time.
4. Funding for Neurologic Music Therapy 2003-2004 21. For the years 2003-2004, please indicate how your services were funded. (Check all that apply) c d e f g
Group/Private Insurance
c d e f g
Private Pay
c d e f g
Other
c d e f g
Medicare
c d e f g
Grants/Endowments
c d e f g
Not in clinical practice at that time
c d e f g
Medicaid
c d e f g
Financed by Facility
c d e f g
Tricare
c d e f g
Government Funds
22. For the years 2003-2004, please indicate by domain the number of clients you were successfully reimbursed for by Medicare, Medicaid, Tricare, Private Insurance or other government funds. (If this does not apply, please skip to the next question) Sensorimotor techniques Cognitive techniques Speech and Language techniques
23. If you did not answer the previous question, please indicate why you did not achieve successful reimbursement during the years 2003-2004. j k l m n
Did not attempt reimbursement during this time.
j k l m n
Attempted but was not successful in getting reimbursement during this time.
5. Funding for Neurologic Music Therapy 2005-2006 24. For the years 2005-2006, please indicate how your services were funded. (Check all that apply) c d e f g
Group/Private Insurance
c d e f g
Private Pay
c d e f g
Other
c d e f g
Medicare
c d e f g
Grants/Endowments
c d e f g
Not in clinical practice at that time
c d e f g
Medicaid
c d e f g
Financed by Facility
c d e f g
Tricare
c d e f g
Government Funds
25. For the years 2005-2006, please indicate by domain the number of clients you were successfully reimbursed for by Medicare, Medicaid, Tricare, Private Insurance or other government funds. (If this does not apply, please skip to the next question) Sensorimotor techniques Cognitive techniques Speech and Language techniques
26. If you did not answer the previous question, please indicate why you did not achieve successful reimbursement during the years 2005-2006. j k l m n
Did not attempt reimbursement during this time.
j k l m n
Attempted but was not successful in getting reimbursement during this time.
6. Funding for Neurologic Music Therapy 2007 27. For the year 2007, please indicate how your services were funded.(Check all that apply) c d e f g
Group/Private Insurance
c d e f g
Private Pay
c d e f g
Other
c d e f g
Medicare
c d e f g
Grants/Endowments
c d e f g
Not in clinical practice at that time
c d e f g
Medicaid
c d e f g
Financed by Facility
c d e f g
Tricare
c d e f g
Government Funds
28. For the year 2007, please indicate by domain the number of clients you were successfully reimbursed for by Medicare, Medicaid, Tricare, Private Insurance or other government funds. (If this does not apply, please skip to the next question) Sensorimotor techniques Cognitive techniques Speech and Language techniques
29. If you did not answer the previous question, please indicate why you did not achieve successful reimbursement during the year 2007. j k l m n
Did not attempt reimbursement during this time.
j k l m n
Attempted but was not successful in getting reimbursement during this time.
7. Funding for Neurologic Music Therapy 1999-2007 30. For all successful reimbursement attempts between 1999 and 2007, please check each step that you completed. (check all that apply) c d e f g
Obtained a doctor’s order for
c d e f g
Became an approved provider for that specific company
c d e f g
Appealed insurance denials.
c d e f g
Received pre-approval from the
c d e f g
Utilized the Medical Coding and
c d e f g
neurologic music therapy
insurance company
c d e f g
codes are appropriate
neurologic music therapy techniques.
Completed an assessment to determine which techniques and
Engaged in treatment utilizing
c d e f g
Did not attempt reimbursement
c d e f g
Was not successful in getting
during this time
reimbursement during this time
Records manual for the purpose of getting reimbursement.
c d e f g
Utilized research articles or research references for the purpose of getting reimbursement.
31. For the years 1999-2007, please indicate which companies reimbursed you for Neurologic Music Therapy services. (check all that apply). c d e f g
Aetna
c d e f g
Golden Rule
c d e f g
Performaz
c d e f g
Assurant
c d e f g
Humana
c d e f g
Tricare
c d e f g
Blue Cross/Blue Shield
c d e f g
IHC Health Plans
c d e f g
Worker's Compensation
c d e f g
Celtic
c d e f g
Kaiser Permanente
c d e f g
United Healthcare
c d e f g
Cigna
c d e f g
Medicare
c d e f g
Other
c d e f g
Cogna
c d e f g
Medicaid
c d e f g
Did not attempt reimbursement
c d e f g
Definity
c d e f g
Pacificare
c d e f g
Was not successful in getting
during this time
reimbursement during this time
32. For all unsuccessful reimbursement attempts between 1999-2007, please identify the reason(s). (check all that apply) c d e f g
Music therapists are not approved
c d e f g
Company does not recognize
c d e f g
Service is specifically excluded
providers for the company
service
from insurance policy
c d e f g
Music therapists are not licensed
c d e f g
Other
c d e f g
Did not attempt reimbursement
by the state
during this time
c d e f g
Was not successful in getting reimbursement during this time