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Who May Bill for Diagnostic Psychological and Neuropsychological Tests
• CPs – see qualifications under chapter 15, section 160 of the Benefits Policy Manual, Pub. 100-02.
• NPs –to the extent authorized under State scope of practice. See qualifications under chapter 15, section 200 of the Benefits Policy Manual, Pub. 100-02.
• CNSs –to the extent authorized under State scope of practice. See qualifications under chapter 15, section 210 of the Benefits Policy Manual, Pub. 100-02.
• PAs – to the extent authorized under State scope of practice. See qualifications under chapter 15, section 190 of the Benefits Policy Manual, Pub. 100-02.
• Independently Practicing Psychologists (IPPs)
• PTs, OTs and SLPs – see qualifications under chapter 15, sections 220-230.6 of the Benefits Policy Manual, Pub. 100-02.
Psychological and neuropsychological tests performed by a psychologist (who is not a CP) practicing independently of an institution, agency, or physician’s office are covered when a physician orders such tests. An IPP is any psychologist who is licensed or certified to practice psychology in the State or jurisdiction where furnishing services or, if the jurisdiction does not issue licenses, if provided by any practicing psychologist. (It is CMS’ understanding that all States, the District of Columbia, and Puerto Rico license
psychologists, but that some trust territories do not. Examples of psychologists, other than CPs, whose psychological and neuropsychological tests are covered under the diagnostic tests provision include, but are not limited to, educational psychologists and counseling psychologists.)
The carrier must secure from the appropriate State agency a current listing of psychologists holding the required credentials to determine whether the tests of a particular IPP are covered under Part B in States that have statutory licensure or certification. In States or territories that lack statutory licensing or certification, the
carrier checks individual qualifications before provider numbers are issued. Possible reference sources are the national directory of membership of the American Psychological Association, which provides data about the educational background of individuals and indicates which members are board-certified, the records and directories of the State or territorial psychological association, and the National Register of Health
Service Providers. If qualification is dependent on a doctoral degree from a currently accredited program, the carrier verifies the date of accreditation of the school involved, since such accreditation is not retroactive. If the listed reference sources do not provide enough information (e.g., the psychologist is not a member of one of these sources), the carrier contacts the psychologist personally for the required information. Generally,
carriers maintain a continuing list of psychologists whose qualifications have been verified.
NOTE: When diagnostic psychological tests are performed by a psychologist who is not practicing independently, but is on the staff of an institution, agency, or clinic, that entity bills for the psychological tests.
The carrier considers psychologists as practicing independently when:
• They render services on their own responsibility, free of the administrative and professional control of an employer such as a physician, institution or agency; • The persons they treat are their own patients; and
• They have the right to bill directly, collect and retain the fee for their services. A psychologist practicing in an office located in an institution may be considered an independently practicing psychologist when both of the following conditions exist:
• The office is confined to a separately-identified part of the facility which is used olely as the psychologist’s office and cannot be construed as extending throughout the entire institution; and
• The psychologist conducts a private practice, i.e., services are rendered to patients from outside the institution as well as to institutional patients.
Labels: Medicare basic concept
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