Psychotherapy Frequently Asked Questions
PA of services be based on units, sessions, visits or hours?
PA of services is based on "hours", not "sessions" or visits.
a provider/staff member call?
The initial PA can be requested by telephone and support staff can call. The caller must have all information on the PA form readily available to continue the call.
type of approval or denial does the provider receive?
Telephone requests receive an approval or denial at the time of the call. No written approval is provided for a PA requested by telephone. A PA number is given at the time of the call for the provider’s records. Providers are required to maintain this PA in the patient’s record and provide to MHD upon request. For PA requests submitted via fax or mail, a response will be faxed when possible or will otherwise be mailed.
an authorization is done by telephone, can the treatment plan, assessment
and last three (3) session notes be E-mailed?
If additional information is needed, the caller will be instructed to fax or mail the PA form and required documentation. This PA will not be approved during the phone call. The first PA request is the initial authorization and any services requested after this are considered continued treatment. A PA request for continued treatment must be accompanied by the current/updated Diagnostic Assessment, current/updated Treatment Plan and the last 3 progress notes for the therapy being requested. On-line submission of required documentation is not currently available.
CPT code 90862 considered an Evaluation Management Component code?
No, procedure code 90862 is for medication management and does not require PA.
is the DSM IV TR diagnosis required on the PA, when the ICD9 diagnosis is
required on the claim and, is a crosswalk available to convert DSM IV TR to
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Book includes information on the additional axis. DSM IV-TR codes can easily be converted to ICD9 codes through crosswalks available on-line.
MO HealthNet denies an authorization, but the patient wishes to continue to
be seen, can the patient be billed the full fee?
If the PA is denied, the patient may be billed only if they have signed an agreement with the provider prior to services being rendered indicating that they will be responsible for payment for specific dates of service and procedures if not covered by MO HealthNet. The provider should complete and follow-through with all requests for information in the PA process to assure payment as appropriate.
is the process when a patient has private insurance or Medicare?
If a patient has private insurance a PA will still be required. Medicare crossovers do not require PA.
are good for a twelve month period unless otherwise indicated. If a patient
is authorized for ten hours, uses eight (8) of the ten hours, is discharged
and returns ten months later, can a provider use the two hours remaining?
If there are hours remaining on the initial PA and the patient returns to treatment with the same provider within 12 months, the provider may access the remaining hours however, it is the provider’s responsibility to confirm the availability of those hours remaining
Crisis Intervention require a PA?
Crisis intervention is a nonscheduled face-to-face contact to resolve a situation of immediate crisis. The situation must be of significant severity to pose a threat to the patient’s well being or is a danger to himself/herself or others. Crisis intervention does not require PA and may be billed by an enrolled provider. A maximum of 6 hours of crisis intervention is allowed per provider per rolling year; additional hours will not be authorized.
does a provider go about "Closing" or "Changing" a PA?
Send a fax to 573-635-6516 or MO HealthNet Division,
PO Box 4800
Jefferson City, MO 65102
a patient sign a release form to close a PA with one provider to obtain service
from another provider requiring a PA?
The patient must sign and date a form or a memo releasing the current PA. The release can be faxed or mailed to the Psychology Help Desk.
a psychologist with an approved PA refer the patient to another psychologist
for objective testing?
Yes, the patient may be referred to another psychologist. However, if the child is under the age of three (3), a PA request and clinical justification must be submitted for approval.
can a copy of the PA form be obtained?
MHD released an updated Psychological Services Request for Prior Authorization form in the May 27, 2005, Volume 27, Number 20 Psychotherapy Bulletin. This updated form has separate boxes for every therapy type MO HealthNet covers under PA. Providers are required to use this new form immediately.
more than eight patients be allowed in Group Therapy?
As of 5/1/05 groups were expanded in size from a maximum of eight (8) to a maximum of ten (10) patients who are not members of the same family. Group therapy is limited to no less than three (3) but no more than ten (10).
we put an authorization number on our claim when using www.emomed.com?
No, the PA number is not required on the claim as there is no field to enter this information. The only number that should be entered in the MO HealthNet Resubmission field is an Internal Control Number (ICN).
define Family Therapy with both parent and child present. Does it have to
be the parent or can it be the grandparent(s) or other siblings?
Family therapy is defined as the treatment of the members of a family together, rather than an individual patient. The family unit is viewed as a social system that affects all its members. A family may be defined as biological, foster, adoptive or other family unit. Family therapy focuses on helping the family function in more positive and constructive ways by exploring patterns of communication and providing support and education. Only one family therapy session may be billed per family per day and each child may not be seen separately with parents and billed as family therapy. Family therapy is provided within a time- limited, goal-specific, face-to-face interaction based upon planned intervention documented in the Treatment Plan developed in response to the issues identified in the Diagnostic Assessment.
we send the original Assessment or the most recent Updated Assessment along
with the Treatment Plan and Progress Notes?
The assessment that is required is the current assessment most pertinent to the Treatment Plan and Progress Notes being submitted. The Diagnostic Assessment must be current-within one year for adults and adolescents (age 13 to 20) or six months for children under 13.
clarify Individual Interactive Therapy?
Individual Interactive Therapy is typically furnished to children. It involves the use of physical aids and non-verbal communication to overcome barriers to therapeutic interaction between the clinician and the patient who has not yet developed, or has lost, either the expressive language communication skills to explain his or her symptoms and response to treatment, or the receptive communication skills to understand the clinician if he/she were to use ordinary adult language for communications. Individual Interactive Therapy should not be confused with Play therapy. Play therapy is not a billable service.
are the modifiers used for?
The AH, AJ, and UD modifiers are indicators of the licensure of the provider. The U8 modifier is used when billing Place of Service (POS) 12 and is a pricing indicator.
had a PA that ended 09-07-06 for a child so why are my claims denying?
The 06-15-06 Psychotherapy Bulletin informed providers that all PAs for children would be closed effective 07-31-06. Providers were instructed to call the Psychology Help Desk for new authorizations beginning 08-01-06.
have claims that are denying saying the patient isnt eligible but I have a
new approved PA for the dates of service, why?
An approved PA does not guarantee payment and MO HealthNet cannot pay for services when a patient is no longer eligible. The approval means the services were deemed to be medically necessary but the patient must be MO HealthNet eligible on the date of service.
the PAs for children ended 07-31-06 will I get another 4 non-Prior Authorized
No, there are no additional 4 non-PA hours when a patient, child or adult, has seen the same psychology/counseling provider within the past 12 months.
approvals are base on patient age, diagnosis, and the type of therapy being
requested. For what length of time is a PA approved?
PAs for adults are approved on a calendar year, with all current PAs to be closed effective 12-31-06. The PAs for children are currently issued for a 12 month time span from 08-01-06 to 07-31-07. A shorter period of time may be authorized based upon provider request
do I know how many units should be billed?
The maximum number of units is based either on the CPT definition or, if there is no time indicated in the CPT, MO HealthNet has assigned a time limit. A description of the codes and unit limit may be found in Section 13.2 of the Psychology manual.