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MIR-2006-8AB, August 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests; Clinical Psychologist Services
Provider Types Affected
Physicians, providers, and/or clinical psychologists who submit claims to Medicare carriers, for diagnostic psychological testing services
Impact on Providers
- CR4400 alerts providers that Medicare may now pay for the services of a clinical psychologist when they supervise the performance of diagnostic psychological testing.
- Under the physician supervision level of four, Medicare’s physician supervision policy is modified so the policy does not apply when the procedure is furnished under the general supervision of a clinical psychologist.
- Medicare carriers are not required to retroactively process claims for the period between January 1, 2005, and the implementation date. Carriers are to reprocess claims that are brought to their attention that have been denied with dates of service on or after January 1, 2005.
Background
Diagnostic psychological testing may now be performed under the general supervision of a clinical psychologist. This change may be found in the revised Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, Section 160 - Clinical Psychologist Services.
As a reminder, to qualify as a clinical psychologist (CP), a practitioner must meet the following requirements:
- Hold a doctoral degree in psychology; and
- Be licensed or certified, on the basis of the doctoral degree in psychology, by the state in which he or she practices, at the independent practice level of psychology to furnish diagnostic, assessment, preventive, and therapeutic services directly to individuals.
Implementation
The implementation date for this instruction is September 21, 2006.
Additional Information
The revised Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, Sections 80 and 160 - Clinical Psychologist Services, is attached to CR4400, which is the official instruction issued to your carrier regarding this change. CR 4400 may be found by going to http://www.cms.hhs.gov/Transmittals/downloads/R51BP.pdf  on the CMS Web site.
If you have questions, please contact your Medicare carrier at their toll-free number which may be found at http://www.cms.hhs.gov/apps/contacts/  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM4400
Related Change Request (CR) #: 4400
Related CR Release Date: June 23, 2006
Effective Date: January 1, 2005
Related CR Transmittal #: R51BP
Implementation Date: September 21, 2006
Do you have your NPI? National Provider Identifiers (NPIs) will be required on claims sent on or after May 23, 2007. Every health care provider needs to get an NPI. Learn more about the NPI and how to apply for an NPI by visiting http://www.cms.hhs.gov/NationalProvIdentStand/ on the CMS Web site.
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