La. Admin. Code tit. 40 § I-5139

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-5139 - Psychiatry

A. General

1. Psychiatric evaluations may be provided as independent medical examinations (IMEs) when requested by the carrier/self-insured employer.

2. Psychiatric evaluations may be provided as consultations when requested by a physician and when authorized by the carrier/self-insured employer.

3. Upon authorization by the carrier/self-insured employer psychiatric treatment may be provided when documentation submitted by the physician to the carrier/self-insured employer substantiates the medical necessity of the treatment and includes the estimated length of treatment.

4. Reimbursement for a routine medical visit rendered by the same physician on the same day as psychiatric therapy is included in the reimbursement for the more comprehensive service.

5. Hypnosis may be reimbursed when it is an integral part of a plan for the treatment of post-traumatic stress disorders arising from on-the-job injuries.

B. Reimbursement

1. Psychiatric Diagnostic Interview (Procedure Code 90801). Reimbursement for this service includes history and mental status determination, development of a treatment plan when treatment is necessary, and the preparation of a written report.

2. Psychological Testing (Procedure Codes 90830, 95880, 95881, 95882)

a. Reimbursement for these procedures includes the administration of the test, scoring interpretation of results and preparation of a written report.

b. In order for appropriate reimbursement to be made, each test must be specifically identified on the HCFA 1500 Form by the appropriate procedure code.

c. The total charge for the test must be entered in Item 24-F on the HCFA 1500 Form.

d. A single unit of service must be entered in Item 24-G for each test.

3. Medical Psychotherapy (Procedure Codes 90841-90853)

a. Individual psychotherapy must be billed under the procedure code most closely approximating the length of the session.

b. Group psychotherapy generally requires 75 to 90 minutes per session. When a psychiatric treatment program includes group sessions routinely scheduled for more or less time than this, appropriate modifiers should be used.

4. Psychiatric services may be reimbursed when billed by Louisiana licensed physicians who are certified by, or who have satisfactorily completed the specialized training requirements of, the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry. These physicians must either perform the service directly or provide direct supervision of qualified mental health professionals performing the service as required under the applicable Louisiana statutes.

5. Psychiatric diagnostic, evaluative and therapeutic procedures must be billed under appropriate CPT procedure codes.

La. Admin. Code tit. 40, § I-5139

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.