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.