Psychological Services under the Incident to Provision (L30715)
Contractor Information
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Contractor Name Wisconsin Physicians Service Insurance Corporation |
Contractor Number 00951, 00952, 00953, 00954, 05102, 05202, 05302, 05402 |
Contractor Type Carrier - MAC B |
LCD Information
Document Information
L30715 LCD Title Psychological Services under the Incident to Provision Contractor's Determination Number PSYCH-013 AMA CPT/ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. |
Primary Geographic Jurisdiction
Oversight Region Original Determination Effective Date For services performed on or after 09/16/2010 Original Determination Ending Date Revision Effective Date For services performed on or after 12/01/2011 Revision Ending Date |
CMS National Coverage Policy
Title
XVIII of the Social Security Act section 1862 (a)(1)(A). This section
allows coverage and payment of those services that are considered to be
medically reasonable and necessary.
Title XVIII of the Social Security Act section 1862 (a)(7). This section excludes routine physical examinations and services
Title XVIII of the Social Security Act section 1833 (e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
§1861 (s) of the Social Security Act.
Medicare Benefit Policy Manual CMS Pub 100-2, 15, §50
42CFR410.26
Fed Reg., November 1, 2001
60.1 - Incident to Physician's Professional Services (Rev. 17, 06-18-04)
60.3 - Incident to Physician's Service in Clinic (Rev. 17, 06-18-04)
10.4 - Items 14-33 - Provider of Service or Supplier Information (Rev. 148, 04-23-04)
MCM Transmittal No. 1463, 1794, Section 2050.2, 2050.3, 2050.4; MCM 2050, 2050.1; 2070, 2390; 3060
IL CIC7, 11/04/96;
Title XVIII of the Social Security Act section 1862 (a)(7). This section excludes routine physical examinations and services
Title XVIII of the Social Security Act section 1833 (e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
§1861 (s) of the Social Security Act.
Medicare Benefit Policy Manual CMS Pub 100-2, 15, §50
42CFR410.26
Fed Reg., November 1, 2001
60.1 - Incident to Physician's Professional Services (Rev. 17, 06-18-04)
60.3 - Incident to Physician's Service in Clinic (Rev. 17, 06-18-04)
10.4 - Items 14-33 - Provider of Service or Supplier Information (Rev. 148, 04-23-04)
MCM Transmittal No. 1463, 1794, Section 2050.2, 2050.3, 2050.4; MCM 2050, 2050.1; 2070, 2390; 3060
IL CIC7, 11/04/96;
Indications and Limitations of Coverage and/or Medical Necessity
The
"incident to" provision also applies to coverage for psychological
services furnished "incident to" the professional services of
non-physician practitioners listed in this policy.
The training requirements and state licensure or authorization of individuals who perform psychological services are intended to ensure an adequate level of expertise in the cognitive skills required for the performance of diagnostic and therapeutic psychological services. Therefore, only the types of individuals listed later in this policy are considered qualified to perform medically necessary psychological services addressed in this policy. Delegation of diagnostic and therapeutic psychological services to personnel not performing within the scope of practice as authorized by state law, under the "incident to" provision, would bypass the safeguards afforded by professional credentialing and state licensure requirements. Such delegated services under the "incident to" provision would be inappropriate, unreasonable, and medically unnecessary, and therefore not covered by Medicare.
A. Only the following types of individuals, when they are performing within their scope of clinical practice as authorized under State law, are qualified to perform the indicated diagnostic and/or therapeutic psychological services under the "incident to" provision:
Doctorate or Masters level Psychologists: 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90845, 90846, 90847, 90849, 90853, 90857, 90880, 90899
Doctorate or Masters level Social Workers: 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90846, 90847, 90849, 90853, 90857, 90899
Clinical Nurse Specialists (CNSs)/Nurse Practitioner: 90801, 90802, 90804 -90815, 90846, 90847, 90849, 90853, 90857, 90880, 90899, (90862, if authorized by the state to prescribe medication)
Masters level Licensed Marriage and Family Therapist: 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90846, 90847, 90849, 90853, 90857, 90899
Licensed Clinical Professional Counselors (LCPCs): 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90846, 90847, 90849, 90853, 90857, 90899
PLEASE NOTE: Doctorate or Masters level Psychologists, Doctorate or Masters level Social Workers, Clinical Nurse Specialists (CNSs), Nurse Practitioner, Masters level Licensed Marriage, Family Therapist and Licensed Clinical Professional Counselors (LCPCs), must meet both the educational and licensing criteria listed in section A and the provisions listed in sections B. and C.
B. Psychological services referenced in the above HCPCS codes may be delegated only to employees who qualify as one of the categories of individuals listed above. For example, a psychiatrist may hire a social worker to perform services "incident to," but the services the social worker may perform must be limited to the services designated by the HCPCS codes listed above. Individuals who are performing services "incident to" a qualified Medicare practitioner are not required to be separately enrolled as an independent practitioner in Medicare. Also, it is not possible for the billing provider to hire and supervise a professional whose scope of practice is outside the provider's own scope of practice as authorized under State law, or whose professional qualifications exceed those of the "supervising" provider. For example, a certified nurse midwife (CNMW) may not hire a psychologist and bill for that psychologists' services under the "incident to" provision, because a psychologist's services are not integral to a CNMW personal professional services and are not regularly included in the CNMW's bill. Even though sections 1861(s)(2)(L) and 1861(gg) of the Social Security Act authorize coverage for services furnished "incident to" a CNMW's services, psychological services are not commonly furnished in CNMW's offices nor within their scope of practice. Similarly even though section 1861(s)(2)(K)(iv) authorizes coverage for services furnished "incident to" a physician assistant's services, a physician assistant would not be qualified to supervise psychological services performed by the types of individuals listed above.
C. Individuals who are not licensed or otherwise authorized by state law to provide psychological services may not provide psychological services under the "incident to" provision. This level of professional credentialing is necessary to appropriately furnish medically necessary services under the "incident to" provision. Psychological services furnished to Medicare beneficiaries under the "incident to" provision by individuals other than those listed above is not covered. (Note: the standards for professional credentialing are higher for these services billed to Medicare Part B than for similar services performed by other mental health professionals not under the "incident to" provision and billed to Medicare Part A. Under the "incident to" provision, services are performed in the place of the billing provider. In order for services performed and billed under the "incident to" provision to be commensurate with the services performed by the billing provider, and therefore medically necessary, this higher standard of professional credentialing is necessary.)
D. Medicare does not pay for routine screening tests. ICD-9-CM code V82.9 (special screening of other conditions, unspecified condition) should be used to indicate screening tests performed in the absence of a specific sign, symptom or complaint. Use of V82.9 will result in the denial of claims as non-covered screening services.
The training requirements and state licensure or authorization of individuals who perform psychological services are intended to ensure an adequate level of expertise in the cognitive skills required for the performance of diagnostic and therapeutic psychological services. Therefore, only the types of individuals listed later in this policy are considered qualified to perform medically necessary psychological services addressed in this policy. Delegation of diagnostic and therapeutic psychological services to personnel not performing within the scope of practice as authorized by state law, under the "incident to" provision, would bypass the safeguards afforded by professional credentialing and state licensure requirements. Such delegated services under the "incident to" provision would be inappropriate, unreasonable, and medically unnecessary, and therefore not covered by Medicare.
A. Only the following types of individuals, when they are performing within their scope of clinical practice as authorized under State law, are qualified to perform the indicated diagnostic and/or therapeutic psychological services under the "incident to" provision:
Doctorate or Masters level Psychologists: 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90845, 90846, 90847, 90849, 90853, 90857, 90880, 90899
Doctorate or Masters level Social Workers: 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90846, 90847, 90849, 90853, 90857, 90899
Clinical Nurse Specialists (CNSs)/Nurse Practitioner: 90801, 90802, 90804 -90815, 90846, 90847, 90849, 90853, 90857, 90880, 90899, (90862, if authorized by the state to prescribe medication)
Masters level Licensed Marriage and Family Therapist: 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90846, 90847, 90849, 90853, 90857, 90899
Licensed Clinical Professional Counselors (LCPCs): 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90846, 90847, 90849, 90853, 90857, 90899
PLEASE NOTE: Doctorate or Masters level Psychologists, Doctorate or Masters level Social Workers, Clinical Nurse Specialists (CNSs), Nurse Practitioner, Masters level Licensed Marriage, Family Therapist and Licensed Clinical Professional Counselors (LCPCs), must meet both the educational and licensing criteria listed in section A and the provisions listed in sections B. and C.
B. Psychological services referenced in the above HCPCS codes may be delegated only to employees who qualify as one of the categories of individuals listed above. For example, a psychiatrist may hire a social worker to perform services "incident to," but the services the social worker may perform must be limited to the services designated by the HCPCS codes listed above. Individuals who are performing services "incident to" a qualified Medicare practitioner are not required to be separately enrolled as an independent practitioner in Medicare. Also, it is not possible for the billing provider to hire and supervise a professional whose scope of practice is outside the provider's own scope of practice as authorized under State law, or whose professional qualifications exceed those of the "supervising" provider. For example, a certified nurse midwife (CNMW) may not hire a psychologist and bill for that psychologists' services under the "incident to" provision, because a psychologist's services are not integral to a CNMW personal professional services and are not regularly included in the CNMW's bill. Even though sections 1861(s)(2)(L) and 1861(gg) of the Social Security Act authorize coverage for services furnished "incident to" a CNMW's services, psychological services are not commonly furnished in CNMW's offices nor within their scope of practice. Similarly even though section 1861(s)(2)(K)(iv) authorizes coverage for services furnished "incident to" a physician assistant's services, a physician assistant would not be qualified to supervise psychological services performed by the types of individuals listed above.
C. Individuals who are not licensed or otherwise authorized by state law to provide psychological services may not provide psychological services under the "incident to" provision. This level of professional credentialing is necessary to appropriately furnish medically necessary services under the "incident to" provision. Psychological services furnished to Medicare beneficiaries under the "incident to" provision by individuals other than those listed above is not covered. (Note: the standards for professional credentialing are higher for these services billed to Medicare Part B than for similar services performed by other mental health professionals not under the "incident to" provision and billed to Medicare Part A. Under the "incident to" provision, services are performed in the place of the billing provider. In order for services performed and billed under the "incident to" provision to be commensurate with the services performed by the billing provider, and therefore medically necessary, this higher standard of professional credentialing is necessary.)
D. Medicare does not pay for routine screening tests. ICD-9-CM code V82.9 (special screening of other conditions, unspecified condition) should be used to indicate screening tests performed in the absence of a specific sign, symptom or complaint. Use of V82.9 will result in the denial of claims as non-covered screening services.
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
Revenue Codes:
CPT/HCPCS Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
| 90801 | PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION |
| 90802 | INTERACTIVE PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF COMMUNICATION |
| 90804 - 90815 | INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACE-TO-FACE WITH THE PATIENT; - INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES |
| 90805 | INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES |
| 90806 | INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT; |
| 90807 | INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES |
| 90808 | INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; |
| 90809 | INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES |
| 90810 | INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACE-TO-FACE WITH THE PATIENT; |
| 90811 | INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES |
| 90812 | INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT; |
| 90813 | INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES |
| 90814 | INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; |
| 90815 | INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES |
| 90845 - 90857 | PSYCHOANALYSIS - INTERACTIVE GROUP PSYCHOTHERAPY |
| 90846 | FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT) |
| 90847 | FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT) |
| 90849 | MULTIPLE-FAMILY GROUP PSYCHOTHERAPY |
| 90853 | GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP) |
| 90857 | INTERACTIVE GROUP PSYCHOTHERAPY |
| 90862 | PHARMACOLOGIC MANAGEMENT, INCLUDING PRESCRIPTION, USE, AND REVIEW OF MEDICATION WITH NO MORE THAN MINIMAL MEDICAL PSYCHOTHERAPY |
| 90880 | HYPNOTHERAPY |
ICD-9 Codes that Support Medical Necessity
Note: ICD-9 codes must be coded to the highest level of specificity.
| XX000 | Not Applicable |
Diagnoses that Support Medical Necessity
Diagnosis that Supports Medical Necessity
Mental, psychoneurotic and personality disorders.
ICD-9 Codes that DO NOT Support Medical Necessity
| V70.1 | GENERAL PSYCHIATRIC EXAMINATION REQUESTED BY THE AUTHORITY |
| V70.2 | GENERAL PSYCHIATRIC EXAMINATION OTHER AND UNSPECIFIED |
| V79.0 | SCREENING FOR DEPRESSION |
| V79.1 | SCREENING FOR ALCOHOLISM |
| V79.2 | SPECIAL SCREENING FOR INTELLECTUAL DISABILITIES |
| V79.3 | SCREENING FOR DEVELOPMENTAL HANDICAPS IN EARLY CHILDHOOD |
| V79.8 | SCREENING FOR OTHER SPECIFIED MENTAL DISORDERS AND DEVELOPMENTAL HANDICAPS |
| V79.9 | SCREENING FOR UNSPECIFIED MENTAL DISORDER AND DEVELOPMENTAL HANDICAP |
| V82.9 | SCREENING FOR UNSPECIFIED CONDITION |
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
Any diagnosis that would indicate the service is performed for screening purposes.
General Information
Documentation
supporting the medical necessity of this item, such as ICD-9 codes, must
be submitted with each claim. Claims submitted without such evidence
will be denied as being not medically necessary.
In addition to ordinary standards of good clinical documentation, the legible identity of the individual rendering the service with his/her professional credentials and date of service must be included in the documentation of each service and available in the medical record.
Documentation must be submitted to Medicare upon request.
Appendices
In addition to ordinary standards of good clinical documentation, the legible identity of the individual rendering the service with his/her professional credentials and date of service must be included in the documentation of each service and available in the medical record.
Documentation must be submitted to Medicare upon request.
NA
Sources of Information and Basis for Decision
Carrier Medical Directors,
Consultants
Medicare Benefit Policy Manual
This policy does not reflect the sole opinion of the contractor or the Contractor Medical Director(s). Although the final decision rests with the contractor, this policy was developed in cooperation with the Carrier Advisory Committee(s), which include representatives of various medical specialty societies.
* - An asterisk indicates a revision to that section of the policy.
Advisory Committee Meeting Notes
Consultants
Medicare Benefit Policy Manual
This policy does not reflect the sole opinion of the contractor or the Contractor Medical Director(s). Although the final decision rests with the contractor, this policy was developed in cooperation with the Carrier Advisory Committee(s), which include representatives of various medical specialty societies.
* - An asterisk indicates a revision to that section of the policy.
Wisconsin: 2/12/2010
Illinois: 1/13/2010
Michigan: 1/27/2010
Minnesota: 1/14/2010
J-5 MAC
(IA,KS, MO, NE) 2/19/2010
Start Date of Comment Period
Illinois: 1/13/2010
Michigan: 1/27/2010
Minnesota: 1/14/2010
J-5 MAC
(IA,KS, MO, NE) 2/19/2010
02/19/2010
End Date of Comment Period
04/05/2010
Start Date of Notice Period
08/01/2010
Revision History Number
X
Revision History Explanation
12/01/2011: one, annual review, no coverage changes.
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
90804 descriptor was changed in Group 1
90805 descriptor was changed in Group 1
90806 descriptor was changed in Group 1
90807 descriptor was changed in Group 1
90808 descriptor was changed in Group 1
90809 descriptor was changed in Group 1
90810 descriptor was changed in Group 1
90811 descriptor was changed in Group 1
90812 descriptor was changed in Group 1
90813 descriptor was changed in Group 1
90814 descriptor was changed in Group 1
90815 descriptor was changed in Group 1
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
Reason for Change
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
90804 descriptor was changed in Group 1
90805 descriptor was changed in Group 1
90806 descriptor was changed in Group 1
90807 descriptor was changed in Group 1
90808 descriptor was changed in Group 1
90809 descriptor was changed in Group 1
90810 descriptor was changed in Group 1
90811 descriptor was changed in Group 1
90812 descriptor was changed in Group 1
90813 descriptor was changed in Group 1
90814 descriptor was changed in Group 1
90815 descriptor was changed in Group 1
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
This LCD has no Related Documents.
LCD Attachments
Billing &Coding Guidelines 12/1/11 (PDF - 17 KB )
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Page Last Updated: Friday, 09-Dec-2011 10:48:55 CST
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