CurrentNew York State Department of HealthPolicy N/A

Clinical Psychology Manual Policy Guidelines

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This policy governs participation, documentation, referral, collaboration, billing, reimbursement, and unacceptable practices for licensed private practicing clinical psychologists providing services to New York State Medicaid recipients. It addresses psychotherapy, psychological testing, Medicare crossover claims, and related payment requirements.

Policy Summary

PayerNew York State Department of Health

PolicyClinical Psychology Manual Policy Guidelines

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionMaintain complete, legible clinical records in English and retain them for six years.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

37 minMinimum individual psychotherapy contact time

75 minMinimum extended crisis psychotherapy contact time

8 patientsMaximum group psychotherapy size

2 individualsMaximum simultaneous testing

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CurrentNew York State Department of HealthPolicy N/A

Clinical Psychology Manual Policy Guidelines

Customize your policy alerts

Sign up for all New York State Department of Health policy alerts

Know when New York State Department of Health releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerNew York State Department of Health

PolicyClinical Psychology Manual Policy Guidelines

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionMaintain complete, legible clinical records in English and retain them for six years.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

37 minMinimum individual psychotherapy contact time

75 minMinimum extended crisis psychotherapy contact time

8 patientsMaximum group psychotherapy size

2 individualsMaximum simultaneous testing

Clinical record retention

3 yearsRequired training or supervised experience

Covered Clinical Psychology Services

Provider eligibility and general participation

Reimbursement requires all applicable provider and service conditions to be met.

Provider eligibility: The provider is an enrolled licensed private practicing clinical psychologist.

Licensure must comply with Article 153 of the New York State Education Law. The psychologist must have at least three years of training or supervised clinical psychology experience and must currently practice professionally, with at least half of that practice devoted to clinical psychological services.

Personal performance: The service is personally provided by the enrolled licensed private practicing clinical psychologist.

Supervision of, or services provided by, unlicensed interns, trainees, assistants, or other individuals are not reimbursable.

Clinical appropriateness: The service is rendered according to standards of good practice, applicable professional ethics, and Medicaid regulations.

If the recipient's prognosis is not favorable after extended psychological care, the provider should consider curtailing or discontinuing psychological services or initiating other means of care.

Referral and collaboration

Except for initial diagnostic evaluation and testing, all of the following apply.

Referral and collaboration: The recipient has a written referral from an authorized referral source and services are rendered in collaboration with the recipient's physician or another appropriate practitioner providing medical services.

Authorized referral sources include the recipient's personal physician or nurse practitioner, an industrial-concern medical director, an appropriate school official, or an official of a voluntary health or social agency. Collaboration may involve the personal physician, nurse practitioner, or a practitioner associated with a clinic serving the recipient.

Individual psychotherapy

Individual psychotherapy is reimbursable when the applicable requirements for the service are met.

Applicable psychotherapy service

Standard individual psychotherapy: The session is an evaluative or therapeutic session involving the patient alone or a collateral, with or without the patient present, and includes at least 37 minutes of patient contact time.At least 37 minutes
A couple's therapy session is considered a single psychotherapy session even when both participants are Medicaid eligible.
Extended crisis psychotherapy: The session is a medically necessary extended session for crisis management due to extenuating circumstances and includes at least 75 minutes of patient contact time.At least 75 minutes
The purpose must be reduction of acute emotional distress requiring immediate attention. A regularly scheduled session lasting longer than one hour solely for patient convenience does not qualify as an extended session.

Group psychotherapy

Group psychotherapy is reimbursable when all of the following are met.

Group psychotherapy: Two or more non-collateral patients are seen in the same setting at the same time for a similar therapeutic purpose, the session lasts 1.5 hours, and the group includes no more than eight patients.1.5 hours; at least 2 non-collateral patients; maximum 8 patients

Psychological testing

Psychological testing is reimbursable when all applicable conditions are met.

Individual psychological testing: The service is the individual administration of recognized, standardized mental health assessment procedures, including behavior rating or adaptive behavior scales, projective techniques, or cognitive/intellectual and personality assessment, and is used for diagnosis, evaluation, or assessment of mental illness, emotional disturbance, or personality or behavioral disorders.

Patient interviews, social histories, and similar checklist or questionnaire assessments are evaluative sessions rather than psychological testing.

Exceptional simultaneous testing: If more than one individual is tested simultaneously, the tests are objective and mechanical, unusual patient-specific circumstances are documented, the psychologist has direct and continuous access to each patient, confidentiality and test integrity are maintained, validity is not compromised, and individual performance is not adversely affected.Maximum 2 individuals tested simultaneously

Routine group administration of psychological tests is not reimbursable.

Medicare crossover

Medicare crossover cost-sharing may be claimed only when both conditions are met.

The service has been approved by Medicare.
The service meets Medicare's conditions for coverage of psychological services.
Medicare's coverage conditions may differ from those used to define reimbursable services under Medicaid. Use the closest comparable coding available in the Procedure Codes and Fee Schedule section of the manual.

Excluded services and settings include services provided in a facility, such as a clinic, from which the clinical psychologist receives a salary or other compensation. Medicaid fee-for-service reimbursement is also unavailable for services provided under Early Intervention, preschool, or school-age supportive health service programs when the psychologist is paid through those programs. Services provided by or supervised by unlicensed interns, trainees, assistants, or other non-enrolled individuals are likewise not reimbursable.

A regularly scheduled individual session lasting longer than one hour solely for patient convenience is not reimbursable as an extended psychotherapy session. Extended individual psychotherapy requires medical necessity due to extenuating circumstances, such as crisis management, and at least 75 minutes of patient contact time.

Routine group administration of psychological tests is not reimbursable. Simultaneous testing may be reimbursable only in unusual, patient-specific circumstances involving objective and mechanical tests, with the required documentation, direct and continuous access to each patient, and no more than two individuals tested simultaneously.

A regularly scheduled psychotherapy session lasting longer than one hour solely for patient convenience is not reimbursable as extended psychotherapy. Extended sessions are covered only when medically necessary due to extenuating circumstances, such as an unscheduled crisis-management session or an unscheduled extension needed to reduce acute emotional distress requiring immediate attention.

Service Duration, Size, and Reporting Limits

Individual psychotherapy

Minimum patient contact timeAt least 37 minutes

Applies toEvaluative or therapeutic individual psychotherapy sessions involving the patient alone or a collateral, with or without the patient present

Billing noteA session with patient contact terminated before 37 minutes is not reimbursable

Extended crisis psychotherapy

Minimum patient contact time1.25 hours, or 75 minutes

Clinical requirementThe extended session must be medically necessary due to extenuating circumstances, such as a crisis management session

Documentation, Referral, and Denial Risks

Documentation Required

Maintain Complete Clinical Records

Maintain complete, legible clinical records in English for every recipient, with information sufficient to justify the diagnosis and warrant treatment. Retain records for six years in accordance with Medicaid regulations.

Recipient's full name, address, Medicaid identification number (CIN), and the date and clock times for each billed session.
A copy of the patient's written referral for psychological services.
Current ICD-10-CM diagnosis and diagnostic impressions for each session.
The recipient's problems, strengths, conditions, disabilities, and needs.
Treatment goals and objectives, estimated treatment duration, proposed treatment, and prognosis.
Chronological progress notes relating progress to the established treatment goals and objectives.
Documentation of collaboration with the patient's personal physician or another appropriate medical provider.
Copies of written reports sent to the patient's referral source.
A summary of the recipient's condition and disposition when treatment is completed or terminated.

New York Medicaid Clinical Psychology Coverage

New York Medicaid covers clinical psychology services for eligible individuals as part of comprehensive health care. The reimbursable scope includes psychological testing, evaluation, and therapeutic procedures appropriate for personality or behavior disorders, as well as testing used to diagnose, evaluate, or assess mental illness, emotional disturbance, and personality or behavioral disorders. Services must be personally provided by an enrolled licensed private practicing clinical psychologist and delivered in accordance with applicable professional standards, ethics, licensure requirements, and Medicaid rules.

Key Service Definitions

Collateral

Who qualifies as a collateralA member of the patient's family or household who regularly interacts with the patient

Relationship to the patientThe person is directly affected by, or capable of affecting, the patient's condition

Service purposeCollateral services support diagnosis, evaluation, therapy, care planning, and a therapeutic home environment

Billing identifierCollateral services are billed under the primary patient's Medicaid identification number

Crisis management session

Session statusAn unscheduled session or an unscheduled extension of a scheduled session

Policy Summary

PayerNew York State Department of Health

PolicyClinical Psychology Manual Policy Guidelines

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionMaintain complete, legible clinical records in English and retain them for six years.

SourceLink

On This Page

Reduction of acute emotional distress requiring immediate attention

Group psychotherapy duration

Required session duration1.5 hours

Patient settingPatients must be seen in the same setting at the same time for a similar therapeutic purpose

Service typeTherapeutic group psychotherapy session

Group psychotherapy size

Minimum group sizeAt least 2 non-collateral patients

Maximum group sizeNo more than 8 patients

Concurrent participationPatients are seen in the same setting at the same time for a similar therapeutic purpose

Simultaneous psychological testing

Maximum simultaneous testingNo more than 2 individuals

Permitted circumstancesOnly due to unusual patient-specific circumstances that are documented in the patients' records

Required safeguardsThe psychologist must have direct access to and continuously monitor each patient without compromising confidentiality, test integrity, test validity, or individual performance

Additional referral reporting

Additional reporting triggerTherapy continues beyond 5 sessions

Required actionProvide additional periodic written reports

Report recipientThe referring physician, clinic, or other referral source

Clinical record retention

Retention period6 years

Records coveredRecipient clinical records

Record standardRecords must be complete, legible, maintained in English, and sufficient to justify the diagnosis and treatment

Documentation Required

Report to the Referral Source

Send a suitable written report to the referring physician, clinic, or other referral source. If therapy extends beyond five sessions, keep the referral source informed through additional periodic written reports and retain copies in the recipient's clinical record.

Denial Risk

Personally Provide Covered Services

Medicaid reimburses only services personally provided by an enrolled, licensed private practicing clinical psychologist. Services provided by unlicensed interns, trainees, assistants, or other individuals are not reimbursable, including supervision of those services.

Denial Risk

Avoid Nonreimbursable Service Settings

Medicaid does not reimburse services rendered in a facility, such as a clinic, from which the clinical psychologist receives a salary or other compensation. Fee-for-service reimbursement is also unavailable for services provided in Early Intervention, preschool, or school-age supportive health service program settings when the psychologist receives payment for psychology services under those programs.

Denial Risk

Meet Psychotherapy Duration and Group-Size Rules

Document and bill psychotherapy only when the applicable time, purpose, and participant limits are met. Sessions that fall below the required minimum or exceed group limits are at risk of denial.

Individual psychotherapy requires at least 37 minutes of patient contact time; a session ending before 37 minutes is not reimbursable.
An extended individual session requires at least 75 minutes of patient contact and must be medically necessary for an extenuating circumstance, such as crisis management involving acute emotional distress. Regularly scheduled sessions longer than one hour for patient convenience are not reimbursable as extended sessions.
Group psychotherapy must last one and one-half hours, involve two or more non-collateral patients seen together for a similar therapeutic purpose, and include no more than eight patients.
A couple's therapy session is treated as a single psychotherapy session, even when both participants are Medicaid eligible.

Denial Risk

Document Allowable Psychological Testing

Use the psychological testing code only for the individual administration of recognized, standardized mental health assessment procedures. Routine group administration is not reimbursable, and simultaneous testing is allowed only under narrowly documented circumstances.

Patient interviews, social histories, and similar checklist or questionnaire assessments are evaluative sessions, not billable psychological testing.
Simultaneous testing of more than one individual is limited to objective and mechanical tests administered because of unusual patient-specific circumstances documented in the records.
Document direct access to and continuous monitoring of each patient, while confirming that confidentiality, test integrity, test validity, and individual performance were not compromised.
No more than two individuals may be tested simultaneously; routine group testing is not reimbursable.

Denial Risk

Obtain and Retain the Required Written Referral

Before services begin, obtain and retain a written referral for every recipient under the care of a licensed private practicing clinical psychologist. The referral must come from an authorized source; billing is at risk when the referral is missing or the recipient was not properly referred.

Acceptable referral sources include the patient's personal physician or nurse practitioner, a medical director in an industrial concern, an appropriate school official, or an official of a voluntary health or social agency.
Keep a copy of the written referral in the recipient's clinical record.

Denial Risk

Avoid Unacceptable Billing and Referral Practices

Do not engage in unacceptable billing or referral practices. Medicaid prohibits billing for services that are freely available to the general public, billing for recipients who were not properly referred, and billing for services provided in whole or in part by someone other than the enrolled licensed clinical psychologist.

Do not offer cash payments to physicians, clinics, or other referral sources.
Do not bill services available free of charge to the general public.
Do not bill services for recipients who were not properly referred.
Do not bill services rendered in part or entirely by an individual other than the enrolled licensed clinical psychologist.

To reduce acute emotional distress

UrgencyThe distress requires immediate attention

Therapeutic hour

Typical session lengthOne hour of individual psychotherapy

Approximate face-to-face contact45 to 50 minutes

Medicaid reimbursement minimumAt least 37 minutes of patient contact time