Behavioral Health Outpatient Services
Figure 3.4 provides coverage details for covered behavioral health services. Note: This chart is not intended to be all-inclusive.
Figure 3.4 Behavioral Health Care Services: Outpatient Coverage Details
| Service |
Description |
Outpatient Psychotherapy
(physician referral and supervision required when seeing licensed or certified mental health counselors and pastoral counselors) |
The following outpatient psychotherapy limits apply:
- Psychotherapy: Two sessions per week, in any combination of the following types:
- Individual (adult or child): 60 minutes per session; may extend to 120 minutes for crisis intervention
- Family or conjoint: 90 minutes per session; may extend to 180 minutes for crisis intervention
- Group: 90 minutes per session
- Collateral visits
- Psychoanalysis
|
| Psychological Testing and Assessment |
Testing and assessment is covered when medically or psychologically necessary and provided in conjunction with otherwise-covered psychotherapy. Psychological tests are considered to be diagnostic services and are not counted toward the limit of two psychotherapy visits per week.
Limitations:
Testing and assessment is generally limited to six hours per fiscal year (October 1–September 30) (Testing requires a review for medical necessity.)
Exclusions:
Psychological testing is not covered for the following circumstances:
- Academic placement
- Job placement
- Child custody disputes
- General screening in the absence of specific symptoms
- Teacher or parental referrals
- Diagnosed specific learning disorders or learning disabilities
|
| Medication Management |
If you take prescription medications for a behavioral health care condition, you must be under the care of a provider who is authorized to prescribe those medications. Your provider will manage the dosage and duration of your prescription to ensure you are receiving the best care possible. |
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