Psychological E&M of non-mental health disorders

Applies to:

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.

Medical policy

Psychological Evaluation and Management of Non-Mental Health Disorders - 91546

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.