3.0 POLICY
Psychological
testing and assessment is a covered benefit when medically or psychologically necessary
and is provided in conjunction with otherwise covered psychotherapy
or as a required part of the assessment and reassessment process
for Applied Behavior Analysis (ABA) under the Comprehensive Autism
Care Demonstration.
Note: Psychological
tests are considered diagnostic services and are not counted against
the number of weekly hours for ABA under the Comprehensive Autism
Care Demonstration.
4.0 EXCLUSIONS
4.1 Payment is specifically
excluded for the Reitan-Indiana battery when administered to a patient under
age five and for self-administered tests to patients under age 13.
4.2 Psychological
testing and assessment as part of an assessment for academic placement.
This exclusion encompasses all psychological testing related to
educational programs, issues or deficiencies. Testing to determine
whether a beneficiary has a learning disability if the primary or
sole basis for the testing is to assess for a learning disability.
4.3 Psychological
testing related to child custody disputes or job placement.
4.4 Psychological
testing done for general screening (in the absence of specific symptoms
of a covered mental disorder) to determine if individuals being
tested are suffering from a mental disorder.
4.5 Teacher and
parental referrals for psychological testing.
4.6 Testing related
to diagnosed specific learning disorders or learning disabilities
is excluded (encompasses reading disorder (also called dyslexia),
mathematics disorder, disorder of written expression and learning
disorder not otherwise specified).
4.7 Testing for a patient in a Residential
Treatment Center (RTC) or Partial Hospitalization Program (PHP)
is included in the per diem rate and can not be separately reimbursed.
Also, payment billed by an individual professional provider not
employed by or under contract with the RTC or PHP is included in the
per diem rate.