Mental Incapacity Evaluation Reimbursement Sample Clauses

Mental Incapacity Evaluation Reimbursement. The Contractor must be enrolled in ProviderOne to receive reimbursement for these services. DSHS restricts Mental Incapacity Evaluation reimbursements to the following services and fees: Service Type Service Description Reimbursement Fee ProviderOne Service Code Additional Conditions Clinical Evaluation When performed by a licensed/contracted psychologist (Taxonomy: 103T00000X) $150.00 96150 Modifier 25 Must be an acceptable written report as described in Exhibit B, Statement of Work. Clinical Evaluation When performed by a licensed/contracted psychiatrist (Taxonomy: 2084P0800X) $170.00 90791 Must be an acceptable written report as described in Exhibit B, Statement of Work. Clinical Evaluation When performed by a licensed/contracted registered Nurse Practitioner (Psychiatric/Mental Health Taxonomy: 363LP0808X) $150.00 96150 Modifier U1 Must be an acceptable written report as described in Exhibit B, Statement of Work. Clinical Evaluation When performed by a licensed/contracted Physician Assistant (Mental Health/Adult Taxonomy: 363A00000X) $150.00 96150 Modifier U2 Must be an acceptable written report as described in Exhibit B, Statement of Work Evaluation of general mental disorders • MMPI-2: Minnesota Multiphasic Personality Inventory* • PAI-II: Personality Assessment Inventory $50.00 $50.00 96101 Modifier U6 96101 Modifier U1 No more than one (1) test from this category per evaluation *May substitute the MMPI-2: Restructured Form provided the report documents why the substitution is necessary. Evaluation of depression • BDI-II: Xxxx Depression Inventory • HAM-D: Xxxxxxxx Rating Scale for Depression $10.00 $10.00 96101 Modifier U7 96101 Modifier U8 No more than one (1) test from this category per evaluation. Evaluation of anxiety • BAI: Xxxx Anxiety Inventory • HAM-A: Xxxxxxxx Rating Scale for Anxiety $10.00 $10.00 96101 Modifier UB 96101 Modifier UC No more than one (1) test from this category per evaluation. Evaluation of cognitive disorders • WAIS-III or WAIS-IV: Wechsler Adult Intelligence Scale • WMS-III: Wechsler Memory Scale • Test of Nonverbal Intelligence, Fourth Edition (XXXX-4) • Trails: Trail Making Test Parts A & B $120.00 $120.00 $30.00 $10.00 96101 Modifier U3 96118 Modifier U4 96101 Modifier U4 96118 Modifier U5 The XXXX is used to evaluate individuals with limited language ability. It is reimbursed instead of and not in addition to the WAIS and WMS. Evaluation of potential memory malingering • Rey Fifteen-Item Memory Test • TOMM: Test of M...
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Related to Mental Incapacity Evaluation Reimbursement

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  • STATEWIDE ACHIEVEMENT TESTING When CONTRACTOR is an NPS, per implementation of Senate Bill 484, CONTRACTOR shall administer all Statewide assessments within the California Assessment of Student Performance and Progress (“CAASP”), Desired Results Developmental Profile (“DRDP”), California Alternative Assessment (“CAA”), achievement and abilities tests (using LEA-authorized assessment instruments), the Fitness Gram with the exception of the English Language Proficiency Assessments for California (“ELPAC”) to be completed by the LEA, and as appropriate to the student, and mandated by XXX xxxxxxxx to LEA and state and federal guidelines. CONTRACTOR is subject to the alternative accountability system developed pursuant to Education Code section 52052, in the same manner as public schools. Each LEA student placed with CONTRACTOR by the LEA shall be tested by qualified staff of CONTRACTOR in accordance with that accountability program. XXX shall provide test administration training to CONTRACTOR’S qualified staff. CONTRACTOR shall attend LEA test training and comply with completion of all coding requirements as required by XXX.

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