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LCD for Psychiatry and Psychology Services (L33632)
See related Articles:
A52825-Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians – Medical Policy Article
A56937-Billing and Coding: Psychiatry and Psychology Services

Contractor Information

Contractor Name: National Government Services, Inc. - Full list of policies of this Medicare Contractor

Contractor Number: 14212

Contractor Type: MAC B

LCD Information

LCD ID Number: L33632 Status: A-Approved

LCD Title: Psychiatry and Psychology Services

Geographic Jurisdiction: Massachusetts Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 01/01/2024

Revision End Date:

CMS National Coverage Policy:

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) of Title XVIII of the Social Security Act excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1862(a)(7) of Title XVIII of the Social Security Act excludes routine physical examination.

Section 1833(e) of Title XVIII of the Social Security Act prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Code of Federal Regulations:

42 CFR, Section 410.27(f) indicates that “nonphysician practitioner” means a clinical psychologist, licensed clinical social worker, physician assistant, nurse practitioner, clinical nurse specialist or certified nurse-midwife.

42 CFR, Section 410.42, describes limitations on coverage of certain services furnished to hospital outpatients.

42 CFR, Section 410.71, describes coverage of clinical psychologist services and supplies incident to a clinical psychologist

42 CFR, Section 410.73 – 410.76, describes coverage of services provided by clinical social workers, physician assistants, nurse practitioners, or clinical nurse specialists.

42 CFR, Section 410.100 – 410.105, describes coverage, exclusions, and requirements for coverage of services furnished to an outpatient at a Comprehensive Outpatient Rehabilitation Facility (CORF).

CMS Publications:

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 6:

    20.4.5 Coverage of Outpatient Diagnostic Services Furnished on or after January 1, 2011
    20.4.6 Outpatient Diagnostic Services Under Arrangement
    20.5.2 Coverage of Outpatient Therapeutic Services Incident to a Physicians Service Furnished on or after January 1, 2010
    70.1 Outpatient Hospital Psychiatric Services (General)
    70.2 Coverage Criteria for Outpatient Hospital Psychiatric Services

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 12:

    40.7 Social and/or Psychological Services

CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1:

    30.1 Biofeedback Therapy
    70.1 Consultations With a Beneficiary’s Family and Associates
    130.1 Inpatient Hospital Stays for the Treatment of Alcoholism
    130.2 Outpatient Hospital Services for Treatment of Alcoholism
    130.3 Chemical Aversion Therapy for Treatment of Alcoholism
    130.4 Electrical Aversion Therapy for Treatment of Alcoholism
    130.5 Treatment of Alcoholism and Drug Abuse in a Freestanding Clinic
    130.6 Treatment of Drug Abuse (Chemical Dependency)
    130.7 Withdrawal Treatments for Narcotic Addictions?
    160.25 Multiple Electroconvulsive Therapy (MECT)

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 1:

    50.2.2 Frequency of Billing for Outpatient and Services to FIs

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12:

    150 Clinical Social Worker (CSW) Services
    160-160.1 Independent Psychologist Services
    170-170.1 Clinical Psychologist Services

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07/16/2024 03:20:49

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