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 (ACD).
Note: Psychological tests are considered
diagnostic services and are not counted against the number of weekly hours
for ABA under the Comprehensive ACD.
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.