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.