Outpatient Psychiatry and Psychology Services

Outpatient psychiatric and psychological services are covered when reasonable and necessary, delivered by state-authorized mental health providers, and provided under a physician-prescribed individualized treatment plan documenting type, amount, frequency, duration, diagnoses, and goals. Specific modalities (diagnostic interviews, psychotherapy, interactive complexity, group/family therapy, testing, ECT, narcosynthesis) have defined documentation and provider restrictions; non-therapeutic administrative services, ADL-training/recreational activities, and biofeedback for psychosomatic disorders are not covered. Payment parity for outpatient mental health services (effective 1/1/2014) and several billing-specific rules (e.g., diagnostic interview once per day, timed psychotherapy codes, testing-time reporting) apply.

"Outpatient psychiatric/psychological services are covered when provided by licensed/authorized providers including physicians (MD/DO), clinical psychologists, clinical social workers, nurse practit..."