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.