R 418.101006 Reimbursement for mental health services.

Rule 1006. (1) A carrier shall only reimburse procedure code 90792 and add on procedure codes 90833, 90836, and 90838 when billed by a psychiatrist who is either a medical doctor (M.D.) or a doctor of osteopathy (D.O.). (2) A licensed psychologist or a limited license psychologist billing for a diagnostic procedure shall be paid the maximum allowable payment or the practitioner's usual and customary fee, whichever is less. (3) A licensed psychologist billing for a therapeutic service shall use modifier -AH and shall be paid the maximum allowable payment or the practitioner's usual and customary charge, whichever is less. (4) For the following providers, therapeutic mental health services shall be reimbursed at 85% of the maximum allowable payment, or the practitioner's usual and customary charge, whichever is less. If a procedure code has a maximum allowable payment of "by report," the maximum allowable payment shall be 85% of the reasonable payment, or the practitioner's usual and customary charge, whichever is less: (a) -AL limited license psychologist. (b) -AJ certified social worker. (c) -LC licensed professional counselor. (d) -MF licensed marriage and family therapist. (5) For the following providers, mental health services shall be reimbursed at 64% of the maximum allowable payment, or the practitioner's usual and customary charge, whichever is less. If a procedure code has a maximum allowable payment of "by report," then the maximum allowable payment shall be 64% of the reasonable payment, or the practitioner's usual and customary charge, whichever is less: (a) -CS limited licensed counselor. (b) -ML limited licensed marriage and family therapist.