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Psychology Services Expanded

December 3, 2013

In accordance with Senate Bill X1-1 (Hernandez, Chapter 4, Statutes of 2013) section 28 and the Patient Protection and Affordable Care Act, effective for dates of service on or after January 1, 2014, psychology services are no longer optional benefits excluded from coverage under the Medi-Cal program.

When medically necessary, eligible Medi-Cal recipients may receive the following mental health outpatient services provided by psychologists and services provided by psychiatrists:

  • Individual and group mental health evaluation and treatment (psychotherapy) rendered by a psychologist
  • Psychological testing when clinically indicated to evaluate a mental health condition
  • Outpatient services for the purposes of monitoring drug therapy
  • Outpatient laboratory, drugs, supplies and supplements
  • Psychiatric consultation
  • Specialty mental health services provided by County Mental Health Plans

The following changes for psychology and psychiatry services are also noted:

  • The two-visit per month limit no longer applies to psychology services.
  • Treatment Authorization Request (TAR) requirements applicable to CPT-4 codes 90785 (interactive complexity), 90791 (psychiatric diagnostic evaluation), 90792 (psychiatric diagnostic evaluation with medical services) and 90863 (pharmacologic management) no longer apply.
  • Codes 90785, 90791, 90792 and 90863 no longer have a frequency limit.
  • Codes 90785, 90791, 90792 and 90863 no longer require an ICD-9-CM diagnosis code in the range of 290 – 319.
  • Code 90785 must be reported with 90791 or 90792
  • Codes 90832 – 90853 (psychotherapy) and 90865 – 90899 (other psychiatric services or procedures) are no longer outpatient services provided by psychiatrists.
  • Code 90863 must be reported with an Evaluation and Management code in the range of 99201 – 99215 (office or other outpatient services).
  • Claims with each of the following criteria must be billed to Medi-Cal:
    • A “mental disorder” in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM)
    • Mild to moderate impairment
    • Treated on an outpatient basis
  • Claims from county-administered specialty mental health services plans must be billed to specialty mental health services

Conditions that the DSM identifies as relational problems, such as couples counseling or family counseling for relational problems, are not covered.

Provider manual changes will be released in a future Medi-Cal Update.