HI 00610.510 Determining When the Limitation Applies

A. General

When the physicians' services were rendered for both a psychiatric and one or more non-psychiatric conditions, the carrier will separate the charges for the psychiatric aspects of treatment from the nonpsychiatric charges.

B. Distinguishing between diagnostic and therapeutic psychiatric services

The outpatient psychiatric limitation in HI 00610.480 is applied to the physician's therapeutic services but not to his diagnostic services (except those administered to follow the progress of a course of psychiatric treatment for a diagnosed condition).

An initial visit to a psychiatrist for his personal professional services often combines diagnostic evaluation and the start of therapy; such a visit is neither solely diagnostic nor solely therapeutic. The initial visit is deemed to be diagnostic so that the limitation does not apply. Separating diagnostic and therapeutic components of a visit is not administratively feasible, and determining the entire visit to be therapeutic is not justifiable since some diagnostic work must be done before even a tentative diagnosis can be made, and certainly before therapy can be instituted. Moreover, the patient should not be disadvantaged because therapeutic as well as diagnostic services are provided in the initial visit. Similarly, when a physician's diagnostic psychiatric services take more than one visit, the limitation does not apply to the additional visits, When a physician bills for more than one visit for his personal professional diagnostic services, the claim must be documented to show the reason(s) for more than one diagnostic visit.


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HI 00610.510 - Determining When the Limitation Applies - 04/03/2015
Batch run: 04/03/2015
Rev:04/03/2015