1.0 POLICY
1.1 Itemized
mental health services, other than individual and group therapy,
which are provided as an incidental part of an inpatient treatment
plan may be covered. This would include miscellaneous ancillary
therapy modalities such as recreational therapy, and art therapy.
1.2 Other therapy
sessions such as family therapy, social services group therapy,
adapt groups and occupational therapy may be covered when rendered
as part of treatment related to an otherwise covered inpatient
stay and when provided by an authorized individual provider.
1.3 Initial
evaluations are considered as other medical services and may be
authorized. They must be directly related to the diagnosis and/or
definitive set of symptoms and rendered by a member of the institution’s
medical and/or professional staff (either salaried or contractual)
and billed for by the hospital.
1.4 Other ancillary services such
as pharmacy, x-rays, and laboratory charges are payable and customarily
billed separately on the institutional claim form.
Note: Therapeutic programs or regimens, which may include
those services outlined in the policy section above, when provided
by authorized individual providers who are employees of the institution, are
not subject to the Regulation limitations for inpatient psychotherapy.