Attention: Psychologists

During the past year, a workgroup consisting of Alabama Medicaid Agency staff and representatives from the Alabama Psychological Association has collaborated to identify changes that enable the agency to maintain a basic package of services while preserving the health care safety net for our most vulnerable citizens.

As a result of this ongoing effort, the following changes will be implemented effective April 1, 2011:

•           A 52 unit annual maximum limit (including any claims with a date of service beginning January 1, 2011) will be imposed for any combination of the following codes:

o           Individual therapy codes 90804, 90806, 90810, 90812, 90816, 90818, 90823 and 90826.

o           Group therapy codes 90846, 90847, 90849 and 90853.

•           Individual and group codes listed above are subject to a limit of one (1) unit per week (effective date of service April 1, 2011 and thereafter). However, providers may bill one individual and one group code within the same week or on the same date of service. Both units will count towards the the 52 unit annual maximum limit.

•           To request an override to the maximum weekly limit, submit documentation of medical necessity and the exceptional circumstance (e.g. how the recipient is an imminent danger to self or others and/or is at risk for hospitalization or decompensation) along with the original CMS-1500 claim form (with the red drop out ink), related progress note(s) and cover letter to the following address:

Mental Health Program Director

Institutional Services

Alabama Medicaid Agency

P.O. Box 5624

Montgomery, AL 36103-5624

A sample cover letter titled “Psychologist Override Request Form” can be found at: http://medicaid.alabama.gov/documents/4.0_Programs/4.4_Medical_Services/4.4.9_Mental_Health_Services/4.4.9.2_Clinical_Psychologists/4.4.9.2_Psychology_Override_Request_Template.pdf

When billing for testing, please note the following:

             o          The date of service billed must be the date the test was given.

o          Providers may bill for testing, scoring, interpretation and report writing in 30-minute increments. However, it is only necessary to document the time spent in face-to-face service delivery.

o          Billing should reflect the total time for face-to-face administration, scoring, interpretation and report writing.

o          The test(s) given on the date of service billed must be documented in the treatment note for post payment review purposes.

Providers with questions should contact Karen Smith via phone at 334-353-4945 or by e-mail at: karen.watkins-smith@medicaid.alabama.gov