LCD for Outpatient Psychiatric Services (L541)

 

Contractor Information

Contractor Name  National Government Services, Inc.   Contractor Number  00308  Contractor Type  FI

LCD Information

LCD ID Number  L541    LCD Title  Outpatient Psychiatric Services    Contractor's Determination Number      AMA CPT / ADA CDT Copyright Statement  CPT codes, descriptions and other data only are copyright 2007 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.     CMS National Coverage Policy  Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section allows coverage and payment for only those services considered medically reasonable and necessary. 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. Code of Federal Regulations, Part 410.71, Clinical psychologist services and supplies incident to clinical psychologist services. Code of Federal Regulations, Part 410.73, Clinical social worker services. Code of Federal Regulations, Part 410.74, Physician assistants’ services Code of Federal Regulations, Part 410.75, Nurse practitioners’ services. Code of Federal Regulations, Part 410.76, Clinical nurse specialists’ services. Code of Federal Regulations, Part 419, Medicare regulations governing Hospital Outpatient Prospective Payment System (OPPS). Federal Register, Vol. 67, No. 212, November 1, 2002. Changes to Hospital OPPS and Calendar Year 2003 Payment rates, Final Rule. CMS, Publication 100-3, Chapter 1, section 70.1. This section details coverage for family counseling and section 170.1 which addresses patient education programs. CMS Manual, Publication 100-2, Chapter 6, sections 70.1-70.2. This section describes outpatient hospital psychiatric services. CMS Manual, Publication 100-2, Chapter 6, section 20.4. This section defines coverage of outpatient therapeutic services and services incident to the services of physicians. CMS Manual, Publication 100-2, Chapter 6, sections 30 and 50-50.5. Publication 100-4, Chapter 17. These sections address coverage of drugs and biologicals and administration. CMS Manual, Publication 100-4, Chapter 4, sections 250.1, 250.2 and 250.4. These sections refer to payment for services furnished by a Critical Access Hospital (CAH). CMS Manual, Publication 100-3, Chapter 1. This chapter discusses Local Coverage Determination (LCD). CMS Manual, Publication 100-3 (formerly Coverage Issues Manual): Outpatient Hospital Services for Treatment of Alcoholism-Chapter 1, Part 2, section 130.1. Treatment of Drug Abuse (Chemical Dependency) - Chapter 1, Part 2, section 130.6. Treatment of Alcoholism and Drug Abuse in a Freestanding Clinic - Chapter 1, Part 2, section 130.5. Chemical Aversion Therapy for Treatment of Alcoholism (Electroversion Therapy, Electro-Shock Therapy, Noxious Faradic Stimulation) - Chapter 1, Part 2, section 130.4. Diagnosis and Treatment of Impotence - Chapter 1, Part 4, section 230.4. Biofeedback Therapy - Chapter 1, Part 1, section 30.1. Change Request (CR) 3194, dated April 30, 2004. This CR refers to the discontinued use of revenue code 0910. Change Request (CR) 3303, dated June 18, 2004. This CR refers to the annual update to ICD-9-CM codes. Change Request (CR) 3343, dated July 23, 2004. This CR refers to a change to the previous CR (3194) regarding the discontinued use of revenue code 0910. Change Request (CR) 3396, dated July 30, 2004. This CR refers to the updates to HCPCS and ICD-9-CM codes for claims not paid under the Outpatient Prospective Payment System (OPPS). Change Request (CR) 4236, dated December 16, 2005. January 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS) Specifications Change Request (CR) 4238, dated December 16, 2005. January 2006 Outpatient Prospective Payment System Outpatient Code Editor (OPPS) Specifications Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0. Change Request (CR) 5643, dated June 15, 2007. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)   Primary Geographic Jurisdiction  Connecticut Delaware New York - Entire State     Secondary Geographic Jurisdiction      Oversight Region  Region II       Original Determination Effective Date  For services performed on or after 10/01/1993     Original Determination Ending Date      Revision Effective Date  For services performed on or after 12/01/2007     Revision Ending Date      Indications and Limitations of Coverage and/or Medical Necessity  Outpatient psychiatric services represent a continum of outpatient psychiatric services, which can complement the services rendered by a physician. These services provide active treatment to individuals with mental disorders. All services, with the exception of certain diagnostic services covered under this benefit, must be rendered incident to a physician’s services (see CMS Manual, Publication 100-2, Chapter 6, section 20.4) and be reasonable and necessary for the diagnosis or treatment of the patient’s condition. For these services, a physician is defined as a psychiatrist or other physician (MD/DO), trained in the treatment of psychiatric disorders. Indications: Outpatient psychiatric services constitute a range of mental health services rendered “incident to” a physician’s service. According to the CMS Manual, Publication 100-2, Chapter 6, section 20.4. Incident to: To be covered as incident to a physician’s services, the services and supplies must be furnished on a physician’s order by hospital personnel under hospital medical staff supervision in the hospital or if outside the hospital off the campus), under the direct personal supervision of a physician who is treating the patient. For example, if a hospital Licensed Clinical Social Worker (LCSW) goes to a patient’s home to give treatment and no physician accompanies the LCSW, the LCSW’s services are not covered. There is no requirement that the physician who orders the hospital services be directly connected with the department which provides the services. Documentation of physician presence at the off-site facility is required. Outpatient Hospital Psychiatric Services must meet the following coverage criteria and be reasonable and necessary for the diagnosis or active treatment of the psychiatric condition of the patient: Reasonable Expectation of Improvement Treatment, at a minimum, is designed to reduce or control the patient’s psychiatric symptoms so as to prevent relapse or hospitalization and to improve or maintain the patient’s level of functioning. It is not necessary that a course of therapy have as its goal restoration of the patient to the level of functioning exhibited prior to the onset of illness, although this may be appropriate for some patients. For many other psychiatric patients, particularly those with long-term, chronic conditions, control of symptoms and maintenance of a functional level to avoid further deterioration or hospitalization is an acceptable level of improvement. “Improvement” in this context is measured by comparing the effect of continuing treatment versus discontinuing it. Where there is a reasonable expectation that if treatment services were withdrawn the patient’s condition would deteriorate, relapse further or require hospitalization, this criterion would be met. For outpatient psychiatric care to be covered, services must benefit the patient as measured by documentation of improvement (decreasing) of the patient’s symptoms and impairments over a reasonable period of time. Documentation of need for continued care includes: Continued level of acute symptoms/impairments which require outpatient psychiatric care Continued level of active participation Ability to actively participate/engage in and benefit from the outpatient psychiatric treatment program Measurable improvement in the symptoms and functional disabilities that necessitated admission Continued assessment of patient status and appropriate modification of treatment overed Services: Outpatient psychiatric services include a spectrum of intensity from very infrequent visits up to several visits per week. Attempts at reducing the level of service should be made at regular intervals, the frequency of which will depend on the level of service being rendered. Medically Necessary Diagnostic Services Diagnostic services include extended or direct observation necessary to determine functioning, interactions, identify problem areas and to formulate a treatment plan. Outpatient diagnostic services may be given in the psychiatric frame of reference by other qualified non-physician practitioners and include the cost of drugs, supplies, biologicals and equipment. Such services, if rendered off-site, do not require direct physician supervision, although the services must be ordered by Medicare authorized physicians (MDs, DOs). Individual and Group Therapy Individual therapy is the use of verbal therapies in formal sessions with one patient, by one or more staff. Group therapy includes all formal group sessions with two or more patients, aiding the patient to reflect and express his/her feelings through modalities that may incorporate the use of music, dance, art, psychodrama and structured play activities for diagnostic and therapeutic purposes. The therapy must contribute to the maintenance or improvement of the patient’s psychiatric function. Individual and group therapies may be provided by other qualified non-physician practitioners authorized through their scope of practice by the state in which they practice. Qualified Non-Physician Practitioner Staff Qualified non-physician practitioners are persons who are qualified by credentials, training and experience to render services under Medicare Part A. Services must be provided by professionals licensed or certified by your state’s Education Department or specialty societies, to provide supervision and direct services related to the treatment of mental illness. Social Workers and psychiatric nurses trained to work with psychiatric patients. Individual, family and group psychotherapy must be performed by individuals authorized through their scope of practice, by the state in which they practice, to provide these services. Qualified non-physician practitioner staff include the following: Certified Alcohol Counselor Creative/Arts Therapist Occupational Therapist Registered Professional Nurse Rehabilitation Counselor Therapeutic Recreation Specialist Clinical Social Worker Clinical Psychologist Nurse Practitioner Physician Assistant Clinical Nurse Specialist Advanced Practice Registered Nurse It is the responsibility of providers to be aware of their own state licensure laws, including changes as they occur. Occupational Therapy Occupational therapy requiring the skills of a qualified occupational therapist; must be a component of the physician’s psychiatric treatment plan for the individual. While occupational therapy may include pre-vocational and vocational assessment and training, when the services are related primarily to specific employment opportunities, work skills or work settings, they are not covered. Drugs and Biologicals Drugs and biologicals must be approved by the Food and Drug Administration (FDA) and furnished to outpatients for therapeutic purposes. Medically necessary drugs and biologicals have to be given intramuscularly (IM) or intravenously (IV) and incident to a physician’s services in order to be covered by Medicare. For further clarification, refer to Medicare News Update 2003-8, dated August 2003. Family Counseling Family counseling services are formal sessions attended by the therapist, patient (beneficiary) and his or her family member(s) and/or significant other, for the primary purpose of treating the patient's condition. Such sessions may be necessary when there is a need to observe the patient's interaction with family members or to assess the capability of family members to aid in the patient's rehabilitation. It is allowable to have the patient leave the session for a brief period if it is deemed medically necessary by the therapist to do so. In certain types of medical conditions (e.g., mute) or a patient who is withdrawn and uncommunicative due to a mental disorder, preventing the patient from being present, the physician may contact relatives and close associates to secure background information to assist in diagnosis and treatment planning. Case Management Case management is the process of linking the individual to the psychiatric service system, with face-to-face patient/client counseling. Services include coordinating the treatment, symptom monitoring and observation to access the patient’s progress/problems in achieving the treatment plan objectives to assure continuity of service. 10.  Vocational Training Vocational training may include vocational and pre-vocational assessment and training when the services are related to job readiness skills with the goal of the patient returning to the work setting. When vocational training is solely related to specific employment opportunities (e.g. computer skills, typing), the training is not covered. 11.  Patient Education Psychiatric patient education includes educational programs, which are closely related to the care and treatment of the patient. Limitations: Clinical exclusions: Group or other services and programs which are composed primarily of activity, social or recreational therapy. Psychosocial programs or services which provide only structured environment, socialization and/or vocational rehabilitation. Psychiatric, medical or organic brain dysfunction problems interfering with the patient’s ability to participate in or benefit from the program. Psychiatric and/or medical symptoms requiring twenty-four(24) hours of supervision at another level of care. Patient demonstrates only custodial, social or recreational care is required. Impaired mental function related to medical conditions that interfere with ability to benefit (e.g., moderate to severe mental retardation and/or dementia of various etiologies). Inability to manage the patient safely at the outpatient psychiatric program level of care. Geriatric Day Care programs which provide social and recreational activities to older individuals who primarily need custodial type supervision are not considered to be reasonable and necessary. Community support groups such as Alcoholics Anonymous, Narcotics Anonymous or Al-Anon. Biofeedback therapy is non-covered by Medicare for psychosomatic conditions. Electrical Aversion Therapy is a behavior modification technique to foster abstinence from ingestion of alcoholic beverages by developing in a patient conditioned aversions to their taste, smell and sight through electrical stimulation. Electrical aversion therapy has not been shown to be safe and effective and therefore is excluded from coverage. Services to a Skilled Nursing Facility (SNF) resident within the scope of services routinely provided by the SNFs License Clinical Social Workers. Preparation of reports for agencies, courts, schools or insurance companies for medicolegal or informational purposes. Screening procedures, and routine medical tests conducted as screening procedures, provided routinely to patient’s without regard to the signs and symptoms of the patient’s mental illness. Multiple seizure electro convulsion therapy Other Covered Services Alcohol and Drug Rehabilitation treatment is a discrete, intensive coordinated program to help patients with the following: Recover from the recent effects of alcohol and other drugs Understand the medical, social and psychological aspects of alcohol and drug dependence generally, and their dependence, specifically Intense educational services such as lectures, films, reading assignments and discussions, including group therapy Individual medical and psychological procedures necessary for diagnosis or treatment of alcohol or drug dependence and its complications or co-existing disorders During the course of treatment it may be appropriate to involve the patient in groups that are educational in nature and based on principles similar to those found in Alcoholics Anonymous, Narcotics Anonymous and Al-Anon. Co-dependency Services Services that are directed toward a dependent (spouse, parents and/or significant others) with a designated psychiatric illness or symptoms, rather than the co-dependent’s coping with anxiety or life’s problems resulting from substance abuse by their significant other. Multiple Family Therapy Treatment of more than one family in the same session. One member from each family, in addition to the patient, must be present at the session. The session must be for the primary purpose of treating the patient's condition. Impotency/Sexual Disorders Sexual problems may be associated with a wide variety of organic and emotional illnesses. Impairment of sexual function may adversely affect many aspects of the patient’s life. Evaluation for treatment of sexual dysfunction includes: An understanding of the physiology and psychology of sexual function An awareness of those organic conditions and emotional disorders commonly associated with impairment of sexual function An appreciation of the patient’s feelings about having a sexual problem An ability to approach the evaluation comfortably and matter-of-factly; and Urological evaluation, including appropriate endocrinologic factors. Psychotherapy for sexual disabilities may be undertaken either with couples or families. Mental Retardation Psychiatric services, which are administered to a mentally retarded beneficiary, are covered only if the beneficiary has a co-existing psychiatric diagnosis. The plan of treatment and goals should address the psychiatric condition. Off-site/Home Visits If hospital personnel are sent off-site, a physician must provide direct personal supervision(e.g., by his/her presence and hands on documentation) for the therapeutic services provided. Court Ordered Services Courts do not determine medical necessity for Medicare coverage. Proper medical documentation is required for coverage decisions related to court matter, e.g. just because a judge orders a person to psychiatric care or jail and he chooses the former, it does not mean that the insurer is compelled to cover the psychiatric care.   Coverage Topic  Mental Health Care (Outpatient)

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. 12x Hospital-inpatient or home health visits (Part B only) 13x Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) 22x SNF-inpatient or home health visits (Part B only) 23x SNF-outpatient (HHA-A also) 74x Clinic-ORF only (eff 4/97); ORF and CMHC (10/91 - 3/97) 75x Clinic-CORF 85x Special facility or ASC surgery-rural primary care hospital (eff 10/94)   Revenue 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. 0250 Pharmacy-general classification 030X Laboratory-general classification 043X Occupational therapy-general classification 0513 Clinic-psychiatric 0900 Psychiatric/psychological treatments-general classification 0901 Psychiatric/psychological treatments-electroshock treatment 0910 Psychiatric/psychological services-general classification 0914 Psychiatric/psychological services-individual therapy 0915 Psychiatric/psychological services-group therapy 0916 Psychiatric/psychological services-family therapy 0918 Psychiatric/psychological services-testing 0942 Other therapeutic services-education/training (include diabetes diet training) 0944 Other therapeutic services-drug rehabilitation 0945 Other therapeutic services-alcohol rehabilitation   CPT/HCPCS 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 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; 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 PSYCHOANALYSIS 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 90865 NARCOSYNTHESIS FOR PSYCHIATRIC DIAGNOSTIC AND THERAPEUTIC PURPOSES (EG, SODIUM AMOBARBITAL (AMYTAL) INTERVIEW) 90870 ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING) 90880 HYPNOTHERAPY 90899 UNLISTED PSYCHIATRIC SERVICE OR PROCEDURE 96101 PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI, RORSCHACH, WAIS), PER HOUR OF THE PSYCHOLOGIST’S OR PHYSICIAN’S TIME, BOTH FACE-TO-FACE TIME ADMINISTERING TESTS TO THE PATIENT AND TIME INTERPRETING THESE TEST RESULTS AND PREPARING THE REPORT 96102 PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI AND WAIS), WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT, ADMINISTERED BY TECHNICIAN, PER HOUR OF TECHNICIAN TIME, FACE-TO-FACE 96103 PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI), ADMINISTERED BY A COMPUTER, WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT 96105 ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUAGE FUNCTION, LANGUAGE COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING, WRITING, EG, BY BOSTON DIAGNOSTIC APHASIA EXAMINATION) WITH INTERPRETATION AND REPORT, PER HOUR 96110 DEVELOPMENTAL TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING TEST II, EARLY LANGUAGE MILESTONE SCREEN), WITH INTERPRETATION AND REPORT 96111 DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE, SOCIAL, ADAPTIVE AND/OR COGNITIVE FUNCTIONING BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS) WITH INTERPRETATION AND REPORT 96116 NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDGMENT, EG, ACQUIRED KNOWLEDGE, ATTENTION, LANGUAGE, MEMORY, PLANNING AND PROBLEM SOLVING, AND VISUAL SPATIAL ABILITIES), PER HOUR OF THE PSYCHOLOGIST’S OR PHYSICIAN’S TIME, BOTH FACE-TO-FACE TIME WITH THE PATIENT AND TIME INTERPRETING TEST RESULTS AND PREPARING THE REPORT 96118 NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECHSLER MEMORY SCALES AND WISCONSIN CARD SORTING TEST), PER HOUR OF THE PSYCHOLOGIST’S OR PHYSICIAN’S TIME, BOTH FACE-TO-FACE TIME ADMINISTERING TESTS TO THE PATIENT AND TIME INTERPRETING THESE TEST RESULTS AND PREPARING THE REPORT 96119 NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECHSLER MEMORY SCALES AND WISCONSIN CARD SORTING TEST), WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT, ADMINISTERED BY TECHNICIAN, PER HOUR OF TECHNICIAN TIME, FACE-TO-FACE 96120 NEUROPSYCHOLOGICAL TESTING (EG, WISCONSIN CARD SORTING TEST), ADMINISTERED BY A COMPUTER, WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT 97003 OCCUPATIONAL THERAPY EVALUATION 97004 OCCUPATIONAL THERAPY RE-EVALUATION 97530 THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT BY THE PROVIDER (USE OF DYNAMIC ACTIVITIES TO IMPROVE FUNCTIONAL PERFORMANCE), EACH 15 MINUTES 97532 DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING (INCLUDES COMPENSATORY TRAINING), DIRECT (ONE-ON-ONE) PATIENT CONTACT BY THE PROVIDER, EACH 15 MINUTES 97533 SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE ADAPTIVE RESPONSES TO ENVIRONMENTAL DEMANDS, DIRECT (ONE-ON-ONE) PATIENT CONTACT BY THE PROVIDER, EACH 15 MINUTES 97535 SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING, MEAL PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ASSISTIVE TECHNOLOGY DEVICES/ADAPTIVE EQUIPMENT) DIRECT ONE-ON-ONE CONTACT BY PROVIDER, EACH 15 MINUTES 97537 COMMUNITY/WORK REINTEGRATION TRAINING (EG, SHOPPING, TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/OR WORK ENVIRONMENT/ MODIFICATION ANALYSIS, WORK TASK ANALYSIS, USE OF ASSISTIVE TECHNOLOGY DEVICE/ADAPTIVE EQUIPMENT), DIRECT ONE-ON-ONE CONTACT BY PROVIDER, EACH 15 MINUTES   ICD-9 Codes that Support Medical Necessity  TRUNCATED DIAGNOSIS CODES ARE NOT ACCEPTABLE. ICD-9-CM code listings may cover a range and include truncated codes. It is the provider’s responsibility to avoid truncated codes by selecting a code(s) carried out to the highest level of specificity and selected from the ICD-9-CM book appropriate to the year in which the service was performed. It is not enough to link the procedure code to a correct, payable ICD-9-CM code. The diagnosis or clinical signs/symptoms must be present for the procedure to be paid. Further, these ICD-9-CM codes can be used only with the conditions listed in the Indications and Limitations sections of this LCD. 290.0 SENILE DEMENTIA UNCOMPLICATED 290.10 - 290.13 PRESENILE DEMENTIA UNCOMPLICATED - PRESENILE DEMENTIA WITH DEPRESSIVE FEATURES 290.20 SENILE DEMENTIA WITH DELUSIONAL FEATURES 290.21 SENILE DEMENTIA WITH DEPRESSIVE FEATURES 290.3 SENILE DEMENTIA WITH DELIRIUM 290.40 - 290.43 VASCULAR DEMENTIA, UNCOMPLICATED - VASCULAR DEMENTIA, WITH DEPRESSED MOOD 290.8 OTHER SPECIFIED SENILE PSYCHOTIC CONDITIONS 290.9 UNSPECIFIED SENILE PSYCHOTIC CONDITION 291.0 - 291.5 ALCOHOL WITHDRAWAL DELIRIUM - ALCOHOL-INDUCED PSYCHOTIC DISORDER WITH DELUSIONS 291.81 ALCOHOL WITHDRAWAL 291.89 OTHER SPECIFIED ALCOHOL-INDUCED MENTAL DISORDERS 291.9 UNSPECIFIED ALCOHOL-INDUCED MENTAL DISORDERS 292.0 DRUG WITHDRAWAL 292.11 DRUG-INDUCED PSYCHOTIC DISORDER WITH DELUSIONS 292.12 DRUG-INDUCED PSYCHOTIC DISORDER WITH HALLUCINATIONS 292.2 PATHOLOGICAL DRUG INTOXICATION 292.81 - 292.84 DRUG-INDUCED DELIRIUM - DRUG-INDUCED MOOD DISORDER 292.89 OTHER SPECIFIED DRUG-INDUCED MENTAL DISORDERS 292.9 UNSPECIFIED DRUG-INDUCED MENTAL DISORDER 293.0 DELIRIUM DUE TO CONDITIONS CLASSIFIED ELSEWHERE 293.1 SUBACUTE DELIRIUM 293.81 - 293.84 PSYCHOTIC DISORDER WITH DELUSIONS IN CONDITIONS CLASSIFIED ELSEWHERE - ANXIETY DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE 293.89 OTHER SPECIFIED TRANSIENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE, OTHER 293.9 UNSPECIFIED TRANSIENT MENTAL DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE 294.0 AMNESTIC DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE 294.8 OTHER PERSISTENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE 294.9 UNSPECIFIED PERSISTENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE 295.00 - 295.05 SIMPLE TYPE SCHIZOPHRENIA UNSPECIFIED STATE - SIMPLE TYPE SCHIZOPHRENIA IN REMISSION 295.10 - 295.15 DISORGANIZED TYPE SCHIZOPHRENIA UNSPECIFIED STATE - DISORGANIZED TYPE SCHIZOPHRENIA IN REMISSION 295.20 - 295.25 CATATONIC TYPE SCHIZOPHRENIA UNSPECIFIED STATE - CATATONIC TYPE SCHIZOPHRENIA IN REMISSION 295.30 - 295.35 PARANOID TYPE SCHIZOPHRENIA UNSPECIFIED STATE - PARANOID TYPE SCHIZOPHRENIA IN REMISSION 295.40 - 295.45 SCHIZOPHRENIFORM DISORDER, UNSPECIFIED - SCHIZOPHRENIFORM DISORDER, IN REMISSION 295.50 - 295.55 LATENT SCHIZOPHRENIA UNSPECIFIED STATE - LATENT SCHIZOPHRENIA IN REMISSION 295.60 - 295.65 SCHIZOPHRENIC DISORDERS, RESIDUAL TYPE, UNSPECIFIED - SCHIZOPHRENIC DISORDERS, RESIDUAL TYPE, IN REMISSION 295.70 - 295.75 SCHIZOAFFECTIVE DISORDER, UNSPECIFIED - SCHIZOAFFECTIVE DISORDER, IN REMISSION 295.80 - 295.85 OTHER SPECIFIED TYPES OF SCHIZOPHRENIA UNSPECIFIED STATE - OTHER SPECIFIED TYPES OF SCHIZOPHRENIA IN REMISSION 295.90 - 295.95 UNSPECIFIED TYPE SCHIZOPHRENIA UNSPECIFIED STATE - UNSPECIFIED TYPE SCHIZOPHRENIA IN REMISSION 296.00 - 296.06 BIPOLAR I DISORDER, SINGLE MANIC EPISODE, UNSPECIFIED - BIPOLAR I DISORDER, SINGLE MANIC EPISODE, IN FULL REMISSION 296.10 - 296.16 MANIC AFFECTIVE DISORDER RECURRENT EPISODE UNSPECIFIED DEGREE - MANIC AFFECTIVE DISORDER RECURRENT EPISODE IN FULL REMISSION 296.20 - 296.26 MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE UNSPECIFIED DEGREE - MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE IN FULL REMISSION 296.30 - 296.36 MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE UNSPECIFIED DEGREE - MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE IN FULL REMISSION 296.40 - 296.46 BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, UNSPECIFIED - BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, IN FULL REMISSION 296.50 - 296.56 BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, UNSPECIFIED - BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, IN FULL REMISSION 296.60 - 296.66 BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, UNSPE