Cal. Code Regs. tit. 22 § 51505.3

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 51505.3 - Psychology Services

(a) Reimbursement for psychology services shall be the usual charges made to the general public not to exceed the maximum reimbursement allowances listed in this section.

(b) Group therapy shall be counseling at least two but not more than eight persons at any session. Group therapy reimbursement shall not be made for sessions which are less than one and one-half hours.

(c) Family therapy shall include at least two members of the immediate family, as defined by subsection (c) of Section 51466. The oldest family member in attendance shall be billed under procedure codes X9508 or X9510. All other family members in attendance shall be billed under procedure code X9512. For Medi-Cal clients:

(1) A MEDI label and Medi-Cal claim form shall be submitted for each Medi-Cal eligible family member in attendance at the family therapy session.

(2) At least two Medi-Cal eligible family members shall be in attendance at the family therapy session.

(3) At least one Medi-Cal eligible family member shall be billed under procedure code X9512 for each family therapy session.

(d) Psychodiagnostic services shall be provided and billed as follows:

(1) Psychodiagnostic services shall include test administration, scoring, and, when required, a written test report summarizing the performance and behavior results. Test administration shall include any pretest interview, pretest instruction and test materials. Test administration shall be concluded within seven consecutive work days. Psychodiagnostic time allowances shall only apply to the psychologist's actual time involved in rendering a given service.

(2) Group psychodiagnostic testing shall include two but not more than eight persons at any session.

(3) Atypical test sessions, where the time allowance for test administration exceeds three hours, shall be fully explained.

(4) The psychodiagnostic tests performed shall be reported on the billing form.

(5) Partial hour allowances shall be used whenever a procedure involves a fraction of an hour.

(6) A computer scored test shall be billed using the computer firm's charge for the service. A computer scored test shall be reimbursed at the computer firm's usual charge up to the maximum allowance listed under procedure code X9536. Additional time required to administer the test or to evaluate the computerized report may be billed as a part of test administration or test scoring, respectively.

(e) Case conference allowances shall be limited to conferences with persons immediately involved in the care or recovery of the client. Case conferences shall be limited to one per patient per month.

(f) The maximum allowance for out-of-office call is payable only for visits to the first client receiving services at any given location on the same day. It shall not apply to services rendered by a hospital outpatient department nor an organized outpatient clinic.

(g) Maximum Allowances shall be as follows:

*Procedure Code*	*Maximum Allowance*
PSYCHOTHERAPY
X9500	Individual, one-half hour	$18.98
X9502	Individual, one hour	38.01
X9504	Individual, one and one-half hour (maximum)	56.98
X9506	Group Therapy, per person, per session	14.48
X9508	Family Therapy, one hour, oldest family member	50.87
X9510	Family Therapy, one and one-half hours (maximum)	76.32
X9512	Family Therapy, each additional family member	1.68
PSYCHODIAGNOSTIC SERVICES
X9514	Test Administration, includes pretest interview one complete hour	$38.01
X9516	two complete hours	75.96
X9518	three complete hours	114.00
X9520	four complete hours	152.01
X9522	five complete hours	189.96
X9524	six complete hours (maximum)	227.98
X9526	partial hour, each 15 minutes	9.49
X9528	Group Test Administration, per person over one, add	14.48
X9530	Test Scoring, one complete hour	38.01
X9532	two complete hours (maximum)	75.96
X9534	partial hours--each 15 minutes	9.49
X9536	Computer Scored Test, per test, at computer firm's usual charge up to a maximum of	18.98
X9538	Written Test Report, when required, one complete hour	38.01
X9540	two complete hours (maximum)	75.96
X9542	partial hour--each 15 minutes	9.49
RELATED PSYCHOLOGY SERVICES
X9544	Case conference, one-half hour	$18.98
X9546	one complete hour (maximum)	38.01
X9548	Out-of-Office call	9.49
X9550	Unlisted Services	By Report

Cal. Code Regs. Tit. 22, § 51505.3

1. Amendment of subsection (g) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84. For prior history, see Register 83, No. 22.
2. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
3. Amendment of subsection (g) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
4. Editorial correction of HISTORY 3. (Register 85, No. 52).
5. Certificate of Compliance as to 8-1-85 order transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
6. Amendment of subsections (c), (c)(3), (d)(6) and (g) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
8. Amendment of subsection (g), new subsection (h) and amendment of NOTE filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52, Items 4260-101-0001 and 0890 (Register 2002, No. 29).
9. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (h), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14105 and 14132, Welfare and Institutions Code; Statutes of 1982, Chapter 1594, Section 77; Statutes of 1983, Chapter 323, Section 149; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; Statutes of 1984, Chapter 268, Section 66; Statutes of 1985, Chapter 111, Items 4260-106-001 and 890; and Statutes of 2000, Chapter 52, Items 4260-101-0001 and 0890.

1. Amendment of subsection (g) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84. For prior history, see Register 83, No. 22.
2. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
3. Amendment of subsection (g) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
4. Editorial correction of History 3. (Register 85, No. 52).
5. Certificate of Compliance as to 8-1-85 order transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
6. Amendment of subsections (c), (c)(3), (d)(6) and (g) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
8. Amendment of subsection (g), new subsection (h) and amendment of Note filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52 Items 4260-101-0001 and 0890 (Register 2002, No. 29).
9. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (h), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).