96100 - Psychological Testing by xiuliliaofz


									ACCESS ALLIANCE OF MICHIGAN, 2-1-00; Reviewed-01-2008
                                     PSYCHOLOGICAL TESTING

Covered Service
Psychological Testing – This service may include both objective and projective psychological assessment
techniques including but not limited to tests of intelligence, achievement, attention, memory, expressive
speech, receptive language, visual motor skills, behavior, social skills, personality and neuropsychological
functioning. A full, limited-licensed, or temporary-limited-licensed psychologist may provide this service.
The beneficiary's clinical record must indicate the name of the person who administered the tests, the
results of the tests, the actual tests administered, and any recommendations. The protocols for testing
must be available for review. This service includes all pre-testing interviews and post-test interpretive

Current AAM Procedure Code                        Unit Type (Current)
  Psychological Testing – 96100                     Hour

Eligibility Criteria and Service Priorities:
1.       Beneficiary is suspected to be experiencing a mental illness, emotional disorder or developmental
         disability, reflected in a primary, validated or provisional, DSM IV or ICD-10 Diagnosis (not
         including V Codes).
2.       The request for psychological testing is not primarily related to the determination of educational
         needs, classroom placement or instructional accommodation for those beneficiaries between the
         ages of birth to 26 who are eligible for a psychoeducational evaluation from a public school entity
         as outlined in the IDEA Act of 1997 and Section 504 of the Rehabilitation Act of 1973.
3.       At least one of the following clinical needs is present:
         A.        Measures of intelligence and adaptive behavior are indicated/required for a determination
                   of Developmental Disability or Mental retardation, and/or to determine the level of
                   cognitive impairment to assist in mental health treatment or care planning.
         B.        Psychological testing is necessary to clarify the necessity and/or degree of guardianship
                   required. The consumer has pursued authorization for this service from their qualified
                   health plan or commercial insurance and has received a notice of denial of coverage.
         C.        Psychological or neuropsychological testing is needed to assist in the differential
                   diagnosis of a mental disorder or neurological disorder as determined by a licensed
                   physician in consultation with a licensed (LP or LLP) psychologist.
         D.        In the case of lack of treatment progress, to determine and/or to recommend the most
                   effective treatment indicators, methods and strategies and/or the prognosis for
                   amelioration of the presenting problem.
4.       If applicable, the assigned psychiatrist concurs with the need to obtain psychological testing.
5.       No valid existing psychological testing is available.

For children or adolescent consumers:
6.      The beneficiary has pursued authorization for this service from their qualified health plan or
        commercial insurance and has received a notice of denial of coverage.

Associated Outcomes
Identification of a plan to improve the health and safety of the consumer through differential diagnosis,
recognition of legal competency issues, accommodation of intellectual capacities and/or investigation of
clinical indicators necessary support the consumer/guardian’s desired future.

Typical Service Utilization Pattern
Any beneficiary receiving services may receive at least one psychological assessment per year if they
meet the above criteria; another psychological testing for the new treatment year may be requested as
early as two months prior to the Person Centered Planning Meeting to assist in treatment planning and
preparation. Additional assessments may be authorized should there be a substantial change in the
beneficiaries clinical presentation.
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