decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 2070 / 2070.2_PsychologicalTests.--
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Article Overview
This article covers Medicare guidance for diagnostic psychological testing furnished by psychologists and how coverage is affected by whether the psychologist is practicing independently or within an institution, agency, clinic, or physician’s office. It is useful for coders, billers, and provider office staff who need to understand the administrative framework for these services under Medicare Part B, including credential verification, ordering physician information, and billing responsibility.
Why This Topic Matters
The article helps readers determine when diagnostic psychological testing may be handled as a covered outpatient diagnostic service and which entity is responsible for billing in different practice settings. It also highlights documentation and qualification checks that affect claims processing for psychology-related services.
Article Sections
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Coverage of diagnostic psychological testing by independent psychologists
Explains Medicare coverage context for diagnostic psychological testing furnished by psychologists and the general outpatient service framework discussed in the manual section.
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Verification of psychologist qualifications
Describes how qualification status may be checked through state, territorial, or professional reference sources when determining whether services meet the relevant coverage conditions.
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Billing responsibility when the psychologist is not independent
Addresses situations where the psychologist is associated with an institution, agency, or clinic and how billing responsibility is handled in those settings.
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Administrative and practice-status considerations
Covers general administrative points related to assignment, claim information, and the factors used to view a psychologist as practicing independently.
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Office practice within an institution
Summarizes the conditions discussed for a psychologist with an office located inside an institution and how private practice activity is considered in that context.
What You Will Learn
- How Medicare frames coverage for diagnostic psychological testing furnished by psychologists
- What kinds of practitioner qualification checks may be relevant
- How billing responsibility can change based on practice setting
- What administrative information may be required on the claim
- Which practice-setting factors are discussed for independent psychology services
Who Should Read This
- Medical coders
- Medical billers
- Provider office staff
- Psychology practices
- Medicare compliance staff
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