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.