Clinician's Services

Introduction

Clinical diagnostic and treatment services to individuals with mental or emotional disorders. Services include, but are not limited to: assessment and evaluation; psychological and neuropsychological assessment and evaluation; individual, family, couple, and group therapy; medication treatment and review. Except for medication treatment and review, clinician’s services do not include those services that are part of another community mental health service, such as psychiatric rehabilitation program components and crisis intervention.

Covered Services

Services are covered for categorically and medically needy recipients.

The following tables list all covered treatment and counseling services for the Adult/Children’s Mental Health Program. The table shows the procedure code, service description, if the service requires prior authorization (Y-yes or N-no).


REHABILITATIVE Services: Physician

 

Procedure CodeDescriptionPA

90792Psychiatric diagnostic interview examination including history, mental status, or dispositionN

H0004Behavioral health counseling and therapy, per 15 minutesN

H0004 HQBehavioral health counseling and therapy, per 15 minutesN

H2010 HQGroup comprehensive medication services, per 15 minutes, maximum 8 clientsN

Registered Nurse

Procedure CodeDescriptionPA

H0031 TDMental health assessment, by non-physician, 90 minutesN

H0004 TDBehavioral health counseling and therapy, per 15 minutesN

H0004 TD HQGroup behavioral health counseling and therapy, per 15 minutesN

H2010 TD HQGroup comprehensive medication services, per 15 minutes, maximum 8 clientsN

Certified Ph.D. Psychologist

Procedure CodeDescriptionPA

H0031 HPMental health assessment by non-physician, 90 minutesN

H0004 HPBehavioral health counseling and therapy, per 15 minutesN

H0004 HP HQGroup behavioral health counseling and therapy, per 15 minutesN

MSW Social Worker;
Principal Occupational Therapist;
Principal Rehabilitation Counselor

Procedure CodeDescriptionPA

H0031 AJMental health assessment by non-physician, 90 minutesN

H0004 AJBehavioral health counseling and therapy, per 15 mintuesN

H0004 AJ HQGroup behavioral health counseling and therapy, per 15 minutesN

Marriage and Family Therapist

Procedure CodeDescriptionPA

H0031 HOMental health assessment by non-physician, 90 minutesN

H0004 HOBehavioral health counseling and therapy, per 15 minutesN

H0004 HO HQGroup behavioral health counseling and therapy, per 15 minutesN

Mental Health Counselor

Procedure CodeDescriptionPA

H0031 HOMental health assessment by non-physician, 90 minutesN

H0004 HOBehavioral health counseling and therapy, per 15 minutesN

H0004 HO HQGroup behavioral health counseling and therapy, per 15 minutesN

Principal Counselor

Procedure CodeDescriptionPA

H0031 UAMental health assessment by non-physician, 90 minutesN

H0004 UABehavioral health counseling and therapy, per 15 minutesN

H0004 UA HQGroup behavioral health counseling and therapy, per 15 minutesN

Counselor

Procedure CodeDescriptionPA

H0031 UAMental health assessment by non-physician, 90 minutesN

H0004 UABehavioral health counseling and therapy, per 15 minutesN

H0004 UA HQGroup behavioral health counseling and therapy, per 15 mintuesN

Child Mental Health Physician

Procedure CodeDescriptionPA

90791Psychiatric diagnostic interview examination including history, mental status, or dispositionN

90837Psychotherapy, office/outpatient facility, 60 minutes face to face with the patientN

90834Psychotherapy, 45 minutes with patient and/or family memberN

90832Psychotherapy, 30 minutes with patient and/or family memberN

H2010Comprehensive medication services, per 15 minutesN

Child Mental Health Psychologist

Procedure CodeDescriptionPA

90791 HPPsychiatric diagnostic interview examination including history, mental status, or dispositionN

90837 HPPsychotherapy office/outpatient facility, 60 minutes face to face with the patientN

90834 HPPsychotherapy 45 minutes with patient and/or family memberN

90832 HPPsychotherapy 30 minutes with patient and/or family memberN

Child Mental Health Social Worker
 

Procedure CodeDescriptionPA

H0031 AJMental health assessment by non-physicianN

H0004 AJBehavioral health counseling and therapy, per 15 minutesN

H0004 HQ AJGroup behavioral health counseling and therapy, per 15 minutesN

H0004 HO HRBehavioral health counseling and therapy, per 15 minutes with patient presentN

H0004 HO HSBehavioral health counseling and therapy, per 15 minutes without patient present N

 

 

Limitations

Prior authorization is required for any clinician’s services in excess of 20 visits in any one calendar year.

Providers may request up to 26 additional visits at one time.

15-20 minute physician or nurse visits are generally used for medication maintenance and thus are needed on a more frequent basis. These visits, along with the 90 minute medication groups, should not be added in when counting visits.

Patient Liability

There is no recipient co-pay or patient liability for services.

All mental health services are subject to Third Party Liability (TPL).

An Explanation of Benefits (EOB) or Explanation of Medicare Benefits (EOMB) is required when billing for an MA recipient who has a primary insurance.

Provider Participation

Limited to Community Mental Health Services provided by community mental health centers and other qualified providers of mental health services who are licensed by the RI Department of Behavioral Health, Developmental Disabilities, and Hospitals and/or the RI Department of Health, and provide services under contract to the Division of Mental Health in accordance with the rules, regulations and standards for licensing of mental health facilities and programs or through prior authorization from the Department of Children, Youth and Families (DCYF).

Only the following clinicians (listed below) who meet the above outlined requirements are eligible to provide services to the appropriate populations through the Medicaid Program:

  • Physicians
  • Registered Nurses and Psychiatric Nurses must be registered by the RI Board of Registration for Nurses.
  • Psychologists must be licensed by the RI Board of Registration for Psychologists.
  • “Social Worker” means a Certified Social Worker (CSW) or a Certified Independent Social Worker (CISW).
  • Counselor shall have at least a Master’s degree from an accredited program in counseling and clinical psychology and the equivalent of one year of full-time supervised clinical experience in a mental health setting. The counselor must also be employed by a Community Mental Health Center (CMHC) or other approved agency.
  • Marriage and Family Therapist shall be certified in the provision of marriage and family therapy by the Rhode Island Department of Health and shall be listed on the active register of therapists in marriage and family practice as maintained by the Administrator of Professional Regulations, RIDOH. The therapist must also be employed by a CMHC or other approved agency.
  • Mental Health Counselor shall be certified in the provision of mental health counseling by the Rhode Island Department of Health and shall be listed on the active register of counselors in mental health as maintained by the Administrator of Professional Regulations, RIDOH. The counselor must also be employed by a CMHC or other approved agency
  • Associate Clinicians (LMFT-A, LMHC-A, LCSW-A) must be licensed by the Rhode Island Department of Health.  Associate clinicians can only enroll as part of a group.

Principal Counselor shall have a least a Master’s degree from an accredited program in counseling or clinical psychology and the equivalent of two years of full-time supervised clinical experience in a mental health setting. The counselor must also be employed by a CMHC or other approved agency.