Psychological E&M of non-mental health disorders
Commercial employer group and commercial individual MyPriority plans
Medicare coverage is determined by the Centers for Medicare and Medicaid Services (CMS); if a coverage determination has not been adopted by CMS, this policy applies.
Psychological evaluation and management services, performed to address difficulties associated with an acute or chronic illness, prevention of a physical illness or disability and maintain health, that do not meet criteria for a psychiatric diagnosis.
Health and behavioral assessments coverage
Priority Health covers health and behavioral assessments and brief interventions provided by licensed clinicians (LP, LLP, LMSW, LPC) when provided as part of a comprehensive medical program approved by Priority Health. Examples include comprehensive spine, weight, feeding disorders, palliative care and advance care planning programs.
The Health and Behavioral Assessment/Intervention is not covered for Medicaid and Healthy Michigan Plan members. It is not covered in the home setting.
See the medical policy for medical necessity criteria and exceptions/limitations to coverage.
Health and behavioral assessments billing
See the medical policy for indications, documentation requirements and coding.
- ADHD services
- Autism services
- Coordination of care
- Depression diagnosis and management
- Discharge process
- Electroconvulsive therapy
- Medicaid behavioral health
- Mental health services
- Neuropsych/psychological exams, testing
- Psychological E&M of non-mental-health disorders
- Substance use disorder services
- Transcranial magnetic stimulation