PART I - Department of Behavioral Health and Developmental ...

Psychological Testing: Psychological Testing – Psycho-diagnostic assessment of emotionality, intellectual abilities, personality and psycho-pathologyTransactionCodeper hr of psychologistor physician time,both face-to-face w/the patient and timeinterpreting testresults and preparingreport)w/ qualifiedhealthcareprofessionalinterpretation andreport, administeredby technician, per hrof technician time,face-to-faceCode Detail Code Mod1Mod2Mod3Mod4Rate Code Detail Code Mod1Practitioner Level 2, In-Clinic 96101 U2 U6 $155.87 Practitioner Level 2, Out-of-Clinic 96101 U2 U7 $187.04Practitioner Level 3, In-Clinic 96102 U3 U6 $120.04 Practitioner Level 4, In-Clinic 96102 U4 U6 $81.18Practitioner Level 3, Out-of-Clinic96102 U3 U7 $146.71 Practitioner Level 4, Out-of-Clinic 96102 U4 U7 $97.42Unit Value 1 hour Maximum Daily Units 5 unitsInitialAuthorization5 units Re-Authorization 5 unitsAuthorizationPeriod180 days Utilization Criteria LOCUS scores:1-6Psychological testing consists of a face-to-face assessment of emotional functioning, personality, cognitive functioning (e.g. thinking, attention, memory) or intellectualabilities using an objective and standardized tool that has uniform procedures for administration and scoring and utilizes normative data upon which interpretation ofresults is based.Mod2Mod3Mod4RateServiceDefinitionAdmissionCriteriaContinuingStay CriteriaDischargeCriteriaPsychological tests are only administered and interpreted by those who are properly trained in their selection and application. The practitioner administering the testensures that the testing environment does not interfere with the performance of the examinee and ensures that the environment affords adequate protections of privacyand confidentiality.This service covers both the face-to-face administration of the test instrument(s) by a qualified examiner as well as the time spent by a psychologist or physician (with theproper education and training) interpreting the test results and preparing a written report.1. A known or suspected mental illness or substance-related disorder; and2. Initial screening/intake information indicates a need for additional undetermined supports and recovery/resiliency planning; andIndividual meets Core Customer eligibility.The Individual’s situation/functioning has changed in such a way that previous assessments are outdated.Each intervention is intended to be a discrete time-limited service that modifies treatment/support goals or is indicated due to change in illness/disorder.FY2013 Provider Manual for Community Behavioral Health Providers Page 89