Clinical Psychological Service Guidelines

(1) Reimbursement for psychological treatment services by any clinician other than a licensed psychiatrist shall be based on reasonableness and necessity and shall be reimbursed at 85% of the fees listed in the rate tables (based on 200% of Medicare). Treatment by a licensed psychiatrist shall be reimbursed based on the fees listed in the rate tables. (2) Whenever such psychological treatment services exceed twelve (12) sessions/visits, then such treatment may be reviewed pursuant to the carrier’s utilization review program in accordance with the procedures set forth in 0800-02-06 of the Bureau’s Utilization Review rules before further psychological treatment services may be certified for payment by the carrier. Failure to properly certify such services as prescribed herein shall result in the forfeiture of any payment for uncertified services. The initial utilization review of psychological treatment services after the first twelve (12) sessions/visits shall, if necessary and appropriate, certify an appropriate number of sessions/visits. If necessary, further subsequent utilization review shall be conducted to certify additional psychological treatment services as is appropriate.