Outpatient Psychotherapy

This LCD covers outpatient psychotherapy when a patient has a psychiatric illness or emotional/behavioral symptoms causing inappropriate behavior or impaired functioning, provided services are delivered by appropriately licensed clinicians and are directly related to the diagnosed condition. Group (≤12), family (face-to-face), interactive-complexity, and crisis psychotherapy are allowable when documented in an active treatment plan with required clinical documentation; psychoanalysis, ECT, biofeedback, hypnotherapy, CNS testing, and non-therapeutic activities (grooming, ADL monitoring, recreational/socialization) are not covered.

"Psychotherapy is medically necessary when the patient has a psychiatric illness or demonstrates emotional/behavioral symptoms causing inappropriate behavior or maladaptive functioning."

Sign up to see full coverage criteria, indications, and limitations.