GUIDELINES FOR THE USE OF PSYCHOLOGICAL SERVICES



198755238125GUIDELINES FOR THE USE OF PSYCHOLOGICAL SERVICESDIVISION OF VOCATIONAL REHABILITATION Florida Department of EducationThe Florida Department of Education, Division of Vocational Rehabilitation (VR) is an equal opportunity employer. It is against the law for VR as a recipient of Federal financial assistance to discriminate against any individual in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation or belief. The application process used by VR to determine eligibility for services, any subsequent services and the entire VR process are subject to these non-discrimination requirements. Auxiliary aids and services are available upon request to individuals with disabilities. VR program receives 78.7 percent of its funding through a grant from the U.S. Department of Education. For the 2021 Federal fiscal year, the total amount of grant funds awarded were $176,836,896. The remaining 21.3 percent of the costs ($47,860,557) were funded by Florida State Appropriations. Revised October 2021.October 20209500095000GUIDELINES FOR THE USE OF PSYCHOLOGICAL SERVICESDIVISION OF VOCATIONAL REHABILITATION Florida Department of EducationThe Florida Department of Education, Division of Vocational Rehabilitation (VR) is an equal opportunity employer. It is against the law for VR as a recipient of Federal financial assistance to discriminate against any individual in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation or belief. The application process used by VR to determine eligibility for services, any subsequent services and the entire VR process are subject to these non-discrimination requirements. Auxiliary aids and services are available upon request to individuals with disabilities. VR program receives 78.7 percent of its funding through a grant from the U.S. Department of Education. For the 2021 Federal fiscal year, the total amount of grant funds awarded were $176,836,896. The remaining 21.3 percent of the costs ($47,860,557) were funded by Florida State Appropriations. Revised October 2021.October 2020BTable of Contents TOC \o "1-3" \h \z \u OVERVIEW PAGEREF _Toc53158287 \h 3OBJECTIVES PAGEREF _Toc53158288 \h 3SECTION I – EVALUATION PAGEREF _Toc53158289 \h 3A.Diagnostic Work PAGEREF _Toc53158290 \h 3B.Individuals With Physical Disabilities PAGEREF _Toc53158291 \h 3C.Individuals Needing Interpreter/Translator for Assessments - PAGEREF _Toc53158292 \h 3D.Types of Testing, Evaluations and Assessments PAGEREF _Toc53158293 \h 4E.Method of Administration, Fee Codes and Length of Time for Testing PAGEREF _Toc53158294 \h 4F.Referral Questions PAGEREF _Toc53158296 \h 4SECTION II – TREATMENT PAGEREF _Toc53158297 \h 5A.Duration PAGEREF _Toc53158298 \h 5B.Qualifications PAGEREF _Toc53158299 \h 5C.Tracking Progress PAGEREF _Toc53158300 \h 5D.Provider of Services PAGEREF _Toc53158301 \h 5E.Medication PAGEREF _Toc53158302 \h 5SECTION III – PSYCHOLOGICAL CONSULTATION PAGEREF _Toc53158303 \h 6A.VR Psychological Consultation Code used for a Psychiatrist PAGEREF _Toc53158304 \h 6B.VR Psychological Consultation Code used for a Psychologist PAGEREF _Toc53158305 \h 6SECTION IV – CODES FOR DIAGNOSTIC/INTERVIEW/ASSESSMENT PAGEREF _Toc53158306 \h 6SECTION V – TESTING ADMINISTRATION AND SCORING CODES PAGEREF _Toc53158307 \h 7SECTION VI – TYPES OF SERVICES REQUESTED PAGEREF _Toc53158308 \h 7A.Learning Disability Assessment/evaluation PAGEREF _Toc53158309 \h 7B.Full Neuropsychological Assessment/evaluation PAGEREF _Toc53158310 \h 9C.Abbreviated Neuropsychological Assessment/EValuation PAGEREF _Toc53158311 \h 10D.Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) PAGEREF _Toc53158312 \h 11E.Autism Assessment/Evaluation PAGEREF _Toc53158313 \h 12F.General Personality Assessment/Evaluation PAGEREF _Toc53158314 \h 13G.General Intellectual Assessment/Evaluation PAGEREF _Toc53158315 \h 14H.Adaptive Functioning ASSESSMENT/Evaluation PAGEREF _Toc53158316 \h 15I.Vocational Interest ASSESSMENT/Evaluation PAGEREF _Toc53158317 \h 16J.Vocational Aptitude ASSESSMENT/Evaluation PAGEREF _Toc53158318 \h 17SECTION VII – ADDITIONAL ASSESSMENT/EVALUATION COMPONENTS PAGEREF _Toc53158319 \h 18A.Standard Cognitive performance testing PAGEREF _Toc53158320 \h 18B.DEVELOPMENTAL TESTING PAGEREF _Toc53158321 \h 18SECTION VIII – PSYCHOTHERAPY CODES PAGEREF _Toc53158322 \h 19A.Psychotherapy codes without medical evaluation and management services PAGEREF _Toc53158323 \h 19B.Add-On Psychotherapy Codes PAGEREF _Toc53158324 \h 19SECTION IX – CODES USED ONLY BY PSYCHIATRISTS PAGEREF _Toc53158325 \h 20A.Psychiatric Evaluation Code PAGEREF _Toc53158326 \h 20B.EVALUATION AND MANAGEMENT (E/M) PAGEREF _Toc53158327 \h 20SECTION X – BEST PRACTICES SUMMARY POINTS PAGEREF _Toc53158328 \h 21SECTION XI – RESOURCES PAGEREF _Toc53158329 \h 22A.ATTACHMENT A – VR CODING REFERENCE PAGEREF _Toc53158330 \h 22B.OTHER RESOURCES PAGEREF _Toc53158331 \h 22C.LINKS TO FREE OR LOW COST MEDICATIONS PAGEREF _Toc53158332 \h 22Should you identify needed changes within this Best Practices Guide or have questions on how to use this tool please contact VRHQPoliciesProcedures@vr.OVERVIEWThese 2020 standards are based on Current Procedural Terminology (CPT) managed by the American Psychological Association (APA). CPT codes are a universal way to classify and describe all medical tests and procedures, and thus, is the basis for the Florida VR service fee code structure. CPT codes are five (5) digits, VR service fee codes are six (6) digits; therefore the last digit (a zero [0], or a one [1]) is for VR classification use only. Providers may vary slightly as to what codes are billed in their practice but these guidelines are provided as a starting point for the counselor to engage the chosen expert. All fees paid are regionally determined by the Centers for Medicare & Medicaid Services (CMS) and mental health professionals other than Psychologists or Psychiatrists are paid at varying levels. This best practices guide has been developed in partnership with several experts in the field; we would like to thank them and many VR field staff for their input and dedication to providing quality services. OBJECTIVESThese guidelines highlight the established standards and policies for the use of mental health professionals within the Division of Vocational Rehabilitation (VR). The goal of VR is to help individuals with disabilities find and maintain employment and enhance their independence.SECTION I – EVALUATIONDiagnosis of mental health disabilities shall be made by a psychiatrist and/or a licensed psychologist. [Reference VR Counselor Policy Manual (CPM), Chapter 4, Section 4.12(1).] Diagnosis by a professional staff with less than an M.D. or Ph.D. credential is acceptable only if such individual(s) are employed by a licensed/certified facility with M.D. or Ph.D. oversight. Please note: Signature of the individual providing oversight is not required. [Reference CPM, Chapter 4, Section 4.11(2)] Diagnostic Work – The psychologist can provide useful information during the diagnostic work-up of an individual. In addition to providing diagnosis of emotional disorders, learning disabilities, intellectual disabilities and neuropsychological issues, the psychologist can evaluate and provide information as to the nature of the individual’s vocational impediment. The psychologist can also provide impressions and recommendations regarding what specific aspect(s) of the individual’s mode of functioning would require an accommodation in order to obtain a successful employment outcome. Individuals With Physical Disabilities – Very often psychological factors represent a significant aspect in the rehabilitation of individuals with severe physical disabilities. In many cases, a psychological evaluation is necessary to clarify variables such as: the individual’s emotional response to the disability, mechanisms for coping with the disability, adjustment potential, self-concept and other related factors. Individuals Needing Interpreter/Translator for Assessments - Valid Assessments require effective communication. Some individuals have a language barrier due to using:1. a foreign spoken language (e.g. Haitian Creole), 2. American Sign Language (ASL), or 3. atypical language (e.g. foreign sign language, lack of formal education, or language influenced by cognitive delays). VR will arrange for any form of interpretation needed to secure a valid and reliable assessment.? ?Interpreter(s) shall be used unless the psychologist is approved to conduct the assessment in the individual’s native language (e.g. the psychologist is fluent in ASL).?? If the individual uses atypical language, a language specialist interpreter shall also be secured for the assessment, whenever possible.??The psychologist performing the assessment must work with the interpreter(s) during at least the interview section, questions and answers (within the scope of the instrument’s directions and within acceptable nonstandard test administration protocols/techniques), as well as during the review of results.? Interpreters will be used during any treatment plan activities to ensure full participation for the individual. All attempts will be made to have the same interpreter(s) for these sessions for the purpose of consistency.? VR will provide interpreting services for treatment if needed, unless other sources are available.If effective communication requires assistance other than interpreting (e.g. CART, Braille docs, translated materials), VR will work to provide the alternative formats whenever possible).Types of Testing, Evaluations and Assessments – The counselor will determine and communicate to the psychologist the purpose of the psychological evaluation in order to assist the psychologist in determining the battery of tests that will be required such as: intellectual, personality, learning disability, adaptive functioning and neuropsychological. The psychological evaluation should have some relevance for the counselor and the individual in establishing and developing a vocational goal. The counselor may also request recommendations regarding the nature of a job environment and/or training best suited for an individual based on his or her psychological profile.Youth in Potentially Eligible status cannot receive psychological evaluations. Youth in other VR statuses may receive psychological evaluations.Please note: Psychologists should not prescribe testing that the counselor does not deem necessary. The counselor and psychologist should discuss the need for any specific testing not on the original authorization.Method of Administration, Fee Codes and Length of Time for Testing – The counselor will communicate with the psychologist to determine appropriate fee codes and which method of test administration should be used for the evaluation (psychologist, technician, or computer). Please note: Specific codes are for varying units of time (half hour, 1 hour). A range of time allowed is identified for most codes. See Attachment A – VR Coding Reference for further assistance when requesting services and creating an authorization for services.Referral Questions – It is important that the counselor obtain a psychological evaluation report of an individual that will include recommendations with vocational implications. To accomplish this, well-formulated referral questions will aid the psychologist in providing the type of information most useful to the referring counselor for a particular case. If a psychologist has a question as to the nature of the information being requested by a counselor, it is often useful for the psychologist to consult with the counselor and indicate the type of referral information generally needed for the psychologist to write the most useful reports in the future. (RIMS Template VCMT009, Request for Psychological Services)SECTION II – TREATMENTIn cases where VR is funding treatment for medical, psychiatric or psychological services, the information can be no older than one year. [Reference CPM, Chapter 6, Section 6.04(2)]. Duration – Psychological treatment services may be provided to help the individual reach an employment outcome. The counselor must follow-up with the treatment provider for recommendations regarding treatment goals and length of treatment. The counselor may request psychological consultation as questions arise. From the standpoint of VR, any psychotherapeutic service would have, as a primary goal, the resolution of those psychological problems or issues, which are contributing to an individual’s inability to return to work or failure to maintain employment once placed on a job.Qualifications – Licensed marriage and family therapists, licensed clinical social workers, licensed psychologists and licensed mental health counselors can provide personal adjustment counseling to individuals to assist them in modifying behaviors that interfere with employment. School psychologists cannot administer neuropsychological tests or formal personality tests like the Minnesota Multiphasic Personality Inventory – 2 (MMPI-2). School psychologists can administer IQ, achievement, and some rating scales assessing autism, learning styles, and adaptive functioning. Tracking Progress – When requesting the provision of treatment services, the counselor will discuss with the provider the goals for treatment to ensure that there is a clear understanding of the purpose of this service to the individual. The provider must submit a written progress report to the counselor within ten (10) business days of the last authorized session [Attachment A – VR Coding Reference] indicating whether the individual is making progress as a result of the treatment. The counselor will assess if the individual is benefiting from this service in terms of an employment outcome and if there is a need to continue treatment.Provider of Services – In cases where psychological treatment (including psychotherapy) has been recommended by a psychologist, psychiatrist or other physician, a counselor may authorize the psychologist to provide the treatment. In any case in which a physician is providing medical treatment and a psychologist is providing psychological treatment concurrently, both should be kept informed of any changes in the individual’s therapeutic regime, which would affect the treatment process. The local community mental health center should be considered as a comparable service for long-term psychotherapy, or when an individual no longer requires services from VR to achieve an employment outcome. [Reference CPM, Chapter 12, Section 12.03(2)]Medication – VR may provide prescription drugs that are necessary to correct or treat a physical or mental condition that constitutes a substantial impediment to employment. [Reference CPM, Chapter 12, Section 12.00(6)]The counselor should obtain a written report from the prescribing physician that details the purpose of the medication, length of projected use and any side effects. Questions regarding these reports may be discussed with the medical or psychological consultant.The counselor must determine whether comparable services and benefits are available under any program other than VR to cover the costs of services. The counselor can further assist the individual by researching low/no cost medications. [See Resources section.]SECTION III – PSYCHOLOGICAL CONSULTATIONA psychological consultant can play a significant role as a consultative resource to the counselor. The psychological consultant will review available data, psychological report(s) and other pertinent information and provide a written recommendation to the counselor as to actions to take with a given individual. The psychological consultant can also assist a counselor by making recommendations as to case management, providing relevant interpretation of psychological evaluations, counseling approaches, psychopathology, appropriate treatment, and prognosis. The psychological consultant may also assist the counselor in making a determination as to whether the individual will be able to benefit from VR services in obtaining employment by interpreting pertinent information. A formal psychological consultation shall not occur with the actual provider of the diagnostic and treatment services under review, unless no other provider is available. [Reference CPM, Chapter 12, Section 12.01(5)] Please complete RIMS template, Medical/Psychological Template VCMT012.VR Psychological Consultation Code used for a Psychiatrist998882VR Psychological Consultation Code used for a Psychologist998881The psychological consultation codes can be used by the psychological consultant to follow-up with the counselor. For example, it can be one to two hours, as needed.SECTION IV – CODES FOR DIAGNOSTIC/INTERVIEW/ASSESSMENT (See Attachment A for further assistance)Psychiatric Diagnostic/Interview – 1 Hour/1 per dayOne of these basic codes will be included in all service requests, assessments/evaluations.PsychologistPsychiatrist907910907920907910 – A Biopsychosocial (diagnostic by a licensed psychologist: diagnostic limited to 1 per day) evaluation may occur on different days. This code should be reported when the service is concluded.907920 - A Biopsychosocial and medical assessment (diagnostic by a psychiatrist: diagnostic limited to 1 per day) that may occur on different days. This code should be reported when the service is concluded.Evaluation TypePurpose Presenting Problem or Possible DiagnosisPsychiatric Evaluation Diagnostic by a PsychiatristA Biopsychosocial and medical assessment (diagnostic limited to 1 unit per day.) This assessment that may occur over several days. This code should be reported when the service is concluded.SECTION V – TESTING ADMINISTRATION AND SCORING CODES (All codes are considered to be Usual, Customary, and Reasonable. See Attachment A for further assistance.)Codes for Test Administration and scoring:Psychologist/PsychiatristTechnicianComputerGeneral PersonalityGeneral IntellectualAdaptive Functioning EvaluationVocational Interest EvaluationVocational Aptitude EvaluationFull NeuropsychologicalAbbreviated NeuropsychologicalLearning Disability Evaluation961360(First 30 minutes)961380(First 30 minutes)961460(No timeframe)Each additional 30 minutes+ 961370+ 961390Standard Cognitive Performance Testing961250(No timeframe)SECTION VI – TYPES OF SERVICES REQUESTED (All codes are considered to be Usual, Customary, and Reasonable. See Attachment A for further assistance.)Learning Disability Assessment/evaluation Evaluation TypePurpose Presenting Problem or Possible DiagnosisLearning Disability EvaluationTo measure academic success, reading, writing and comprehension levels. Detect learning disabilities (reading, math, written expression, etc.) and identify other cognitive difficulties. Transition students in Exceptional Student Education (ESE)Individualized Education Plan (IEP) HoldersIndividuals with a history of failing classes in school or being held backIndividual with deficits in recalling/memorizing or understanding instruction or information.Individual reports intellectual disability and/or difficulty with learning in school. Individual reports difficulty with school in reading, writing and/ or math. Neurobehavioral Status Exam – required for this type of assessment – 1-8 hours 961160Neurobehavioral status exam – First hour (max 1 unit) + 961210Each additional hour (max 7 units)A neurobehavioral status exam is intended to describe the process of gathering clinical information that is used to assess brain dysfunction and the progression and change in symptoms over time, as given by the physician or psychologist with subsequent interpretation and report by the physician or psychologist. A physical health (vs mental health) diagnosis is associated with this code and is completed prior to the administration of neuropsychological testing. The status exam involves clinical assessment of the patient, collateral interviews (as appropriate), and review of prior records. The interview would involve clinical assessment of several domains including, but not limited to, thinking, reasoning, and judgment (e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities). The clinical assessment would determine the types of tests and how those tests should be administered.It includes time for interpreting test results and report preparation. However, as the testing related to the neurobehavioral status exam is only done by the physician or psychologist, there are no codes for technician or computer administration.Test Administration and Scoring – 4-6 HoursPSYCHOLOGIST / PSYCHIATRIST961360Two or more tests, any method – First 30 minutes (max one unit)+961370Each additional 30 minutes (max 11 units)BY TECHNICIAN961380Two or more tests, any method – First 30 minutes+961390Each additional 30 minutes BY AUTOMATED/COMPUTER961460Psychological or Neuropsychological test with single automated instrumentTest Evaluation (interpretation and report prep) - 2-4 Hours961320Test evaluation – First hour (max 1 unit)+ 961330Each additional hour (max 3 units)May also include…Developmental Testing (see Section VII-B for further information)961121Developmental Testing – First hour (max 1 unit) + 961131Each additional half hour (max 3 units)Full Neuropsychological Assessment/evaluationEvaluation TypePurpose Presenting Problem or Possible DiagnosisFull Neuropsychological EvaluationUsed to assess an individual’s brain functions. Includes measures of processing speed, executive functioning, attention, learning, memory, language, nonverbal skills, orientation, visual perception, intelligence and may include measure of emotional functioning.Traumatic brain injury ComaDementiaStrokeEpilepsyBrain InfectionsSudden change in cognitive functioningProlonged Substance AbuseFalls or Accidents resulting in a loss of consciousnessNeurobehavioral Status Exam – required for this type of assessment – 1-8 hours (See Neurobehavioral Status Exam under A. Learning Disability Assessment/Evaluation for further information)961160Neurobehavioral status exam – First hour (max 1 unit) + 961210Each additional hour (max 7 units)Test Administration and Scoring (IQ testing always required) - 6-8 HoursPSYCHOLOGIST / PSYCHIATRIST961360Two or more tests, any method – First 30 minutes (max 1 unit)+961370Each additional 30 minutes (max 15 units)BY TECHNICIAN961380Two or more tests, any method – First 30 minutes+961390Each additional 30 minutes BY AUTOMATED/COMPUTER961460Psychological or Neuropsychological test with single automated instrumentTest Evaluation (interpretation and report preparation) - 3-5 Hours961320Test evaluation – First hour (max 1 unit) + 961330Each additional hour (max 4 units)May also include…Developmental Testing (see Section VII-B for further information)961121Developmental Testing – First hour (max 1 unit) + 961131Each additional half hour (max 3 units)Abbreviated Neuropsychological Assessment/EValuationEvaluation TypePurpose Presenting Problem or Possible DiagnosisAbbreviated Neuropsychological Evaluation To gain information regarding processing speed, executive functioning, memory, language, nonverbal skills.Traumatic brain injurySeizuresMultiple SclerosisConcussionStrokeAutism Spectrum Disorder (ASD), ADD, ADHD, Prolonged Substance Abuse, Falls or Accidents that result in loss of consciousness. Neurobehavioral Status Exam – required for this type of assessment – 1-8 hours (See Neurobehavioral Status Exam under A. Learning Disability Assessment/Evaluation for further information)961160Neurobehavioral status exam – First hour (max 1 unit) + 961210Each additional hour (max 7 units)Test Administration and Scoring (IQ testing always required) - 4-6 HoursPSYCHOLOGIST / PSYCHIATRIST961360Two or more tests, any method – First 30 minutes (max 1 unit) +961370Each additional 30 minutes (max 11 units)BY TECHNICIAN961380Two or more tests, any method – First 30 minutes+961390Each additional 30 minutes BY AUTOMATED/COMPUTER961460Psychological or Neuropsychological test with single automated instrument3. Test Evaluation (interpretation and report prep) - 2-4 Hours961320Test evaluation – First hour (max 1 unit)+ 961330Each additional hour (max 3 units)May also include…Developmental Testing (see Section VII-B for further information)961121Developmental Testing – First hour (max 1 unit) + 961131Each additional half hour (max 3 units)Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD)ADD/ADHD is a neuropsychological process and may require more intensive data collection; preferably from family, peer, and work settings, if possible. When additional diagnostics are requested, seek advice from your local psychological consultant. If you are not doing an academic assessment and want to rule out ADD/ADHD, use the following codes:Evaluation TypePurpose Presenting Problem or Possible DiagnosisAttention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) EvaluationTo measure an individual’s capacity to concentrate, information retention, distractibility, mental stamina, hyperactivity, behavioral symptoms (disruptive & impulsivity).ADD/ADHD is a neuropsychological process and may require more intensive data collection; preferably from family, peer, and work settings, if possible. Individuals who struggle to pay attention or with memory retentionStudents receiving accommodations under other health impaired (OHI)Individuals taking (or have taken) ADHD medicationsNeurobehavioral Status Exam – required for this type of assessment – 1-8 hours (See Neurobehavioral Status Exam under A. Learning Disability Assessment/Evaluation for further information)961160Neurobehavioral status exam – First hour (max 1 unit) + 961210Each additional hour (max 7 units)Test Administration and Scoring - 3-5 HoursPSYCHOLOGIST / PSYCHIATRIST961360Two or more tests, any method – First 30 minutes (max 1 unit)+961370Each additional 30 minutes (max 9 units) BY TECHNICIAN961380Two or more tests, any method – First 30 minutes+961390Each additional 30 minutes BY AUTOMATED/COMPUTER961460Psychological or Neuropsychological test with single automated instrumentTest Evaluation (interpretation and report prep) -2-4 Hours 961320Test evaluation – First hour (max 1 unit) + 961330Each additional hour (max 3 units)May also include…Developmental Testing (see Section VII-B for further information)961121Developmental Testing – First hour (max 1 unit) + 961131Each additional half hour (max 3 units)Autism Assessment/Evaluation Evaluation TypePurpose Presenting Problem or Possible DiagnosisAutism EvaluationTo establish a diagnosis for Autism Spectrum Disorder.Prior diagnosis of Autism, Asperger’s or Pervasive Developmental DisorderHistory of developmental delaysDifficulty interacting with or relating to individuals their own ageSocial difficulties/Poor eye contact1. Psychiatric Diagnostic/Interview – 1 Hour/max 1 unit per dayPsychologistPsychiatrist907910907920Test Administration and Scoring (IQ testing can be added if necessary) - 1-2 HoursPsychologist/Psychiatrist961360 Two or more tests, any method – First 30 minutes (max 1 unit) +961370 Each additional 30 minutes (max 3 units)BY TECHNICIAN961380 Two or more tests, any method – First 30 minutes +961390 Each additional 30 minutes BY AUTOMATED/COMPUTER961460Psychological or Neuropsychological test with single Automated InstrumentTest Evaluation (interpretation and report prep) - 1-3 Hours961300Test evaluation – First hour (max 1 unit) + 961310Each additional hour (max 2 units)General Personality Assessment/Evaluation Evaluation TypePurpose Presenting Problem or Possible DiagnosisGeneral Personality EvaluationTo assess disorders associated with emotional distress that significantly and adversely affects how an individual functions.May present as: Depression, Anxiety, Post Traumatic Stress Disorder (PTSD, Mood disorder, Interpersonal Problems.Psychotic disordersPersonality disordersAnxiety disordersDepressive disordersBipolar related disordersTrauma disordersDissociative disordersSomatic disordersEating disordersGender DysphoriaConduct disordersPersons with a history of behavioral problems, trouble maintaining employment, hallucinations, delusions or psychotropic drug use.Psychiatric Diagnostic/Interview – 1 Hour/max 1 unit per dayPsychologistPsychiatrist907910907920Test Administration and Scoring - 2-3 HoursPsychologist/Psychiatrist961360 Two or more tests, any method – First 30 minutes (max 1 unit) +961370 Each additional 30 minutes (max 5 units)BY TECHNICIAN961380 Two or more tests, any method – First 30 minutes +961390 Each additional 30 minutes BY AUTOMATED/COMPUTER961460Psychological or Neuropsychological test with single Automated InstrumentTest Evaluation (interpretation and report prep) - 2-4 Hours961300Test evaluation – First hour (max 1 unit) + 961310Each additional hour (max 3 units)General Intellectual Assessment/EvaluationEvaluation TypePurpose Presenting Problem or Possible DiagnosisGeneral Intellectual EvaluationTo measure intellectual (IQ) and/or cognitive ability (aptitude/intelligence) relating to vocational goals. Feasibility of college or trade school, capacity to perform simple and complex bine with Adaptive Functioning to determine intellectual disability. Use when individuals report receiving a Standard Diploma through access points. Partner with Learning Disability Assessment.Psychiatric Diagnostic/Interview – 1 Hour/max 1 unit per dayPsychologistPsychiatrist907910907920Test Administration and Scoring - 2 HoursPsychologist or Psychiatrist961360 Two or more tests, any method – First 30 minutes (max 1 unit) +961370 Each additional 30 minutes (max 3 units)BY TECHNICIAN961380 Two or more tests, any method – First 30 minutes +961390 Each additional 30 minutes BY AUTOMATED/COMPUTER961460Psychological or Neuropsychological test with single Automated InstrumentTest Evaluation (interpretation and report prep) - 1-3 Hours961300Test evaluation – First hour (max 1 unit) + 961310Each additional hour (max 2 units)Must also include if evaluating for Intellectual Disability:Adaptive Functioning Testing - 1 HourPSYCHOLOGIST OR PSYCHIATRIST961360 Two or more tests, any method – First 30 minutes (max 1 unit) +961370 Each additional 30 minutes (max 1 unit)BY TECHNICIAN961380Two or more tests, any method – First 30 minutes +961390Each additional 30 minutes Adaptive Functioning ASSESSMENT/EvaluationIf you are assessing whether or not an Intellectual Disability exists, you must also request a General Intellectual Evaluation (Reference Section VI, G).Evaluation TypePurpose Presenting Problem or Possible DiagnosisAdaptive Functioning EvaluationTo measure the level of functioning of ADL (Activity of Daily Living skills) overall socialization and coping skills.Required to be included with General Intellectual Evaluation for evaluation of an Intellectual Disability. Assesses how effectively individuals cope with common life demands and how well they meet the standards of personal independence.Individuals with prior IQ below 70, prior history of Intellectual Disability (ID), or suspected Intellectual Disability.Students graduating with Special Diplomas or Certificates of Completion.Potentially for individuals with Cerebral Palsy, Traumatic Brain Injury or Autism to assess adaptive skills if deficits are known or expected.Psychiatric Diagnostic/Interview – 1 Hour/max 1 unit per dayPsychologistPsychiatrist907910907920Test administration and scoring (IQ testing can be added if necessary) - 1-2 hoursPSYCHOLOGIST/PSYCHIATRIST961360Two or more tests, any method – First 30 minutes (max 1 unit) +961370Each additional 30 minutes (max 3 units)BY TECHNICIAN961380Two or more tests, any method – First 30 minutes+961390Each additional 30 minutes BY AUTOMATED/COMPUTER961460Psychological or Neuropsychological test with single Automated InstrumentTest Evaluation (interpretation and report prep) - 1-3 Hours961300Test evaluation – First hour (max 1 unit) + 961310Each additional hour (max 2 units)Vocational Interest ASSESSMENT/EvaluationEvaluation TypePurpose Presenting Problem or Possible DiagnosisVocational Interest EvaluationTo assess an individual that is unsure or not clear of appropriate vocational interests.Vocational interest evaluations help individuals who are changing careers, returning to work or entering work for the first time to determining their career interests.Not necessary if planning to complete a vocational evaluation.Psychiatric Diagnostic/Interview - 1 Hour/max 1 unit per dayPSYCHOLOGISTPSYCHIATRIST907910907920Test Administration and Scoring – 1-2 HoursPSYCHOLOGIST / PSYCHIATRIST961360Two or more tests, any method – First 30 minutes (max 1 unit)+961370Each additional 30 minutes (max 3 units)BY TECHNICIAN961380Two or more tests, any method – First 30 minutes+961390Each additional 30 minutes BY AUTOMATED/COMPUTER961460Psychological or Neuropsychological test with single automated instrumentTest Evaluation (interpretation and report prep) - 1-2 Hours961300Test evaluation – First hour (max 1 unit) + 961310Each additional hour (max 1 unit)Vocational Aptitude ASSESSMENT/Evaluation Evaluation TypePurpose Presenting Problem or Possible DiagnosisVocational Aptitude EvaluationTo give an indication of which jobs match the individual’s personality, overall aptitude and skill level.Vocational Aptitude Evaluations help individuals who are changing careers, returning to work or entering work for the first time to determine either best career options or what level of work they are most suited for.Assess individuals’ vocational aptitudes. Not necessary if planning to complete a vocational evaluation.Psychiatric Diagnostic/Interview – 1 Hour/max 1 unit per dayPSYCHOLOGISTPSYCHIATRIST907910907920Test Administration and Scoring - 1-2 HoursPSYCHOLOGIST / PSYCHIATRIST961360Two or more tests, any method – First 30 minutes (max 1 unit)+961370Each additional 30 minutes (max 3 units)BY TECHNICIAN961380Two or more tests, any method – First 30 minutes+961390Each additional 30 minutes BY AUTOMATED / COMPUTER961460Psychological or Neuropsychological test with single automated instrumentTest Evaluation (interpretation and report prep) - 1-2 Hours961300Test evaluation – First hour (max 1 unit) + 961310Each additional hour (max 1 unit)SECTION VII – ADDITIONAL ASSESSMENT/EVALUATION COMPONENTS Standard Cognitive performance testingBrief testing component used with other diagnostic assessments.Evaluation TypePurpose Presenting Problem or Possible DiagnosisStandard Cognitive Performance TestingCognitive testing checks for problems with cognition. Cognition is a combination of processes in your brain that's involved in almost every aspect of your life. Forgetting appointments and important eventsLosing things oftenHaving trouble coming up with words that you usually knowLosing your train of thought in conversations, movies, or booksIncreased irritability and/or anxietyIt includes thinking, memory, language, judgment, and the ability to learn new things. A problem with cognition is called cognitive impairment. The condition ranges from mild to severe.There are many causes of cognitive impairment. They include side effects of medicines, blood vessel disorders, depression, and dementia. Cognitive testing can't show the specific cause of impairment. But testing can help determine if more tests are needed and/or identify steps to address the problem.961250No time frame (max 1 Unit add-on)DEVELOPMENTAL TESTINGThe developmental testing codes, may vary by provider, but should be reported when a standardized instrument is used to assess developmental skill acquisition or developmental status. Developmental testing measures skill development in multiple areas, such as receptive and expressive language and social, cognitive, gross and fine motor, and adaptive functioning.The main distinction between these developmental testing codes and the neurobehavioral status codes is the use of a standardized element. The neurobehavioral status exam does not require the completion of a standardized instrument. It represents an interview to collect clinical information, often before formal testing begins.961121Developmental Testing – First hour (max 1 unit) + 961131Each additional half hour (max 3 units)SECTION VIII – PSYCHOTHERAPY CODES (Use in all settings; time is with patient and/or family ONLY; Pays 25% less to mental health professionals other than psychologists or psychiatrists)Evaluation TypePurpose Presenting Problem or Possible DiagnosisPsychotherapyOften used as a general category to describe a therapeutic meeting, or referenced as a treatment approach, or long-term therapyNot a diagnosisUsed with or without an add-on (or pair) codePsychotherapy codes without medical evaluation and management services908320 30 minutes908340 45 minutes (standard)908370 60 minutesAdd-On Psychotherapy CodesPsychotherapy with medical evaluation and management services are reported with a psychotherapy add-on code. For Psychotherapy sessions lasting longer than 90 minutes, reimbursement will only be made if the report is supported by the medical record documenting the face-to-face time spent with the patient, and the medical necessity for the extended time.+ 908330Individual and family member –30 minutes + 908360Individual and family member – 45 minutes + 908380Individual and family member – 60 minutes + 907850Interactive complexity – when specific communication difficulties are present with individuals who typically: Have other individuals legally responsible for their care, such as minors or adults with guardians, or Request others to be involved in their care during the visit, such as adults accompanied by one or more participating family members or interpreter or language translator, or Require the involvement of other third parties, such as child welfare agencies, parole or probation officers, or schools. Interactive complexity may be reported with psychiatric procedures when at least one of the following communication difficulties is present: The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care. Caregiver emotions/behaviors that interfere with implementation of the treatment plan. Evidence/disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants. Use of play equipment, physical devices, interpreter or translator to overcome significant language barriers.SECTION IX – CODES USED ONLY BY PSYCHIATRISTSPsychiatric Evaluation Code907920Psychiatric Diagnostic/Interview 1 Hour/1 unit per dayEVALUATION AND MANAGEMENT (E/M) Codes are only based on the time frame and meeting all components detailed in each description. These codes are generally used for medication management.Evaluation TypePurpose Presenting Problem or Possible DiagnosisMedication ManagementMedication Management is used by a Psychiatrist to review and determine effectiveness of medical care plan.Not a diagnosisOften referred to as an Evaluation/Maintenance (E/M) codingPsychotherapy with medical evaluation and management services are reported with a psychotherapy add-on code.New Patient (face-to-face with patient and/or family)For new patients, three (3) components are required. For example: 992021 - Problem-focused history; problem-focused examination; and medical decision making/20 minutes. The 3 components of that fee code would be 1) history, 2) examination and 3) medical decision making.99202120 minutes99203130 minutes99204145 minutes99205160 minutesEstablished Patient (face-to-face with patient and/or family)For established patients, two (2) out of the three (3) components are required.9921115 minutes (This fee code does not have associated components)99212110 minutes99213115 minutes99214125 minutes99215140 minutesSECTION X – BEST PRACTICES SUMMARY POINTSIt is important that the counselor obtain a psychological evaluation report of an individual that will include recommendations with vocational implications. To accomplish this, well-formulated referral questions will aid the psychologist in providing the type of information most useful to the referring counselor for a particular case. If a psychologist has a question as to the nature of the information being requested by a counselor, it is often useful for the psychologist to consult with the counselor and indicate the type of referral information generally needed for the psychologist to write the most useful reports in the future.Per the APA, “It is absolutely essential that all of the Testing Evaluation Services and Test Administration and Scoring services provided by the psychologist/neuropsychologist and technician are documented in a comprehensive and transparent way. This should include a table within the report listing dates and total times for each activity, (including scoring and clinical decision making), as well as a log sheet with clear start/stop times in the clinical chart.”When requesting the provision of treatment services, the counselor will discuss with the provider the goals for treatment to ensure that there is a clear understanding of the purpose of this service to the individual.Please note: Psychologists should not prescribe testing that the counselor does not deem necessary. The counselor and psychologist should discuss the need for any specific testing not on the original authorization.Ask the provider before appointment how many units of +961370 and how many units of +961310 (or +961330) they anticipate.There are different codes for the first unit and then the additional units of each type of service. We refer to them as code pairs. The additional units of each type are in purple font and have a plus sign (+) before the code, see coding examples below.The VR guidance documents have each type of evaluation listed separately, but often, the request is for a combination of types. For example, you want an LD and a GP. You can only use the “first unit code” one time on each authorization. Even though it is listed once under LD and once under GP. (See Attachment A – VR Coding Reference)VR’s guidelines have the number of UNITS per type of testing. However, some units are in hours and some units are in 30 minute increments. Make sure to do the math if it is a 30 minute code. For example, Test Administration and Scoring - 2-3 HoursPsychologist/Psychiatrist961360 Two or more tests, any method – First 30 minutes (max 1 unit) +961370 Each additional 30 minutes (max 5 units)Another example, Test Evaluation (interpretation and report prep) - 2-4 Hours961300Test evaluation – First hour (max 1 unit) + 961310Each additional hour (max 3 units)The counselor will communicate with the psychologist to determine appropriate fee codes and which method of test administration should be used for the evaluation (psychologist, technician, or computer).ALL Test Administration and Scoring codes are the same. It doesn’t matter if it is IQ, GP, LD, or Neuro. To administer and score, it is always 961360/+961370. These are all 30 min codes. The abbreviated neuro status is still 961160 for the first hour.Report writing and interpreting. If the report is a psychological (GP/LD/AF/Voc int/Voc apt) then the codes for report writing are 961300/+961310. If it is a neuropsychological (or abbreviated, LD, or ADHD) it is 961320/+961330, these are all hour long codes. SECTION XI – RESOURCESATTACHMENT A – VR CODING REFERENCE This attachment offers an alternative view of these codes based on the type of assessment/evaluation requested. Attachment A may be helpful for VR staff when developing an authorization on which codes to include on the starting number of units to authorize. A best practice is to learn from and work in partnership with your chosen vendor. Note in Attachment A we have provided a standard number of units, per code that are appropriate levels to create an authorization. Should your chosen vendor require more units then they should provide VR an explanation as to why they needed the additional time. Be sure to review the additional guidance provided within Attachment A.Attachment A – VR Coding Reference OTHER RESOURCESAmerican Psychological Association Guidance Documents, 2019 HYPERLINK "" 2019 Psychological and Neuropsychological Testing CPT Codes & Descriptions HYPERLINK "" APA Psychological FAQs HYPERLINK "" Crosswalk for 2019 Psychological Testing and Evaluation CPT Codes HYPERLINK "" Crosswalk for 2019 Neuropsychological Testing and Evaluation CPT Codes HYPERLINK "" Crosswalk for 2019 Computerized Test CPT CodesHYPERLINK ""Centers for Medicare & Medicaid Services, Evaluation and Management Services LINKS TO FREE OR LOW COST MEDICATIONS1. Medicine Assistance Tool2. National Alliance on Mental Illness (NAMI) - Getting help paying for medicinesShould you identify needed changes within this Best Practices Guide or have questions on how to use this tool please contact VRHQPoliciesProcedures@vr. ................
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