Plain Text Law

Regulation .05 Fee Schedule — Treatment Services — Diagnosis and Therapy.

Regulation .05 Fee Schedule — Treatment Services — Diagnosis and Therapy.Copy Citation

A.
Diagnostic Interview. The Department shall reimburse a provider for a face-to-face diagnostic interview, as follows:
(1)
For a child or adolescent, when rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:
(a)
OMHC ... $190.23;
(b)
Physician ... $151.68;
(c)
Psychologist ... $121.08;
(d)
Other mental health professionals ... $106.01;
(2)
For an adult:
(a)
OMHC ... $170.32;
(b)
Physician ... $151.68;
(c)
Psychologist ... $121.08;
(d)
Other mental health professional ... $106.01.
B.
Individual Therapy. The Department shall reimburse a provider for an individual therapy session, as follows:
(1)
For a child or adolescent, when rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:
(a)
For 30 minutes:
(i)
OMHC ... $59.19;
(ii)
Physician ... $50.05;
(iii)
Psychologist ... $40.09;
(iv)
Other mental health professional ... $34.98;
(b)
For 20 — 30 minutes, with biofeedback training:
(i)
OMHC ... $50.05;
(ii)
Physician ... $50.05;
(iii)
Psychologist ... $40.09;
(iv)
Other mental health professional ... $34.98;
(c)
For 45 minutes:
(i)
OMHC ... $105.20;
(ii)
Physician ... $90.94;
(iii)
Psychologist ... $72.65;
(iv)
Other mental health professional ... $63.77;
(d)
For 45 — 50 minutes, with biofeedback training:
(i)
OMHC ... $90.94;
(ii)
Physician ... $90.94;
(iii)
Psychologist ... $72.65;
(iv)
Other mental health professional ... $63.77;
(e)
For 60 minutes in an OMHC ... $105.20;
(2)
For an adult:
(a)
For 30 minutes:
(i)
OMHC ... $50.05;
(ii)
Physician ... $50.05;
(iii)
Psychologist ... $40.09;
(iv)
Other mental health professional ... $34.98;
(b)
For 20 — 30 minutes, with biofeedback training:
(i)
OMHC ... $50.05;
(ii)
Physician ... $50.05;
(iii)
Psychologist ... $40.09;
(iv)
Other mental health professional ... $34.98;
(c)
For 45 minutes:
(i)
OMHC ... $90.94;
(ii)
Physician ... $90.94;
(iii)
Psychologist ... $72.65;
(iv)
Other mental health professional ... $63.77;
(d)
For 45 — 50 minutes, with biofeedback training:
(i)
OMHC ... $90.94;
(ii)
Physician ... $90.94;
(iii)
Psychologist ... $72.65;
(iv)
Other mental health professional ... $63.77;
(e)
For 60 minutes in an OMHC ... $90.94.
C.
Family Therapy. The Department shall reimburse a provider for a family therapy session, as follows:
(1)
When the identified patient is a child or adolescent and the service is rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:
(a)
Without the identified patient:
(i)
OMHC ... $104.13;
(ii)
Physician ... $85.02;
(iii)
Psychologist ... $69.96;
(iv)
Other mental health professional ... $53.81;
(b)
With the identified patient, for 20 — 30 minutes:
(i)
OMHC ... $58.65;
(ii)
Physician ... $58.65;
(iii)
Psychologist ... $46.82;
(iv)
Other mental health professional ... $41.17;
(c)
With the identified patient, for 45 — 60 minutes:
(i)
OMHC ... $107.62;
(ii)
Physician ... $94.71;
(iii)
Psychologist ... $76.41;
(iv)
Other mental health professional ... $65.64;
(2)
When the identified patient is an adult:
(a)
Without the identified patient for 45 — 60:
(i)
OMHC ... $90.14;
(ii)
Physician ... $85.02;
(iii)
Psychologist ... $69.96;
(iv)
Other mental health professional ... $53.81;
(b)
With the identified patient, for 45 — 60 minutes:
(i)
OMHC ... $94.71;
(ii)
Physician ... $94.71;
(iii)
Psychologist ... $76.41;
(iv)
Other mental health professional ... $65.64.
D.
Group Therapy. The Department shall reimburse a provider for each individual, up to a maximum of 10, in a group therapy session as follows:
(1)
When the identified patient is a child or adolescent and the service is rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:
(a)
For 45 — 60 minutes:
(i)
OMHC ... $40.90;
(ii)
Physician ... $24.75;
(iii)
Psychologist ... $24.75;
(iv)
Other mental health professional ... $24.75;
(b)
For more than 75 minutes in an OMHC ... $50.58;
(2)
When the identified patient is an adult:
(a)
For 45 — 60 minutes:
(i)
OMHC ... $38.74;
(ii)
Physician ... $24.75;
(iii)
Psychologist ... $24.75;
(iv)
Other mental health professional ... $24.75;
(b)
For more than 75 minutes in an OMHC ... $50.58.