Reimbursement for psychological evaluations and testing is limited to the terms and conditions outlined in the Community Services Division (CSD) Mental Incapacity Evaluation contract.
For information about contracting with DSHS please visit the CSD Mental Incapacity Evaluations contracts page.
CSD Contractors must be enrolled in ProviderOne to claim reimbursement for these services. Please visit the Health Care Authority’s New Providers page for information about ProviderOne enrollment.
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. |
Evaluation of general mental disorders |
|
$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 |
|
$10.00
$10.00 |
96101 Modifier U7
96101 Modifier U8 |
No more than one (1) test from this category per evaluation. |
Evaluation of 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 |
|
$120.00
$120.00
$30.00
$10.00 |
96101 Modifier U3
96118 Modifier U4
96101 Modifier U4
96118 Modifier U5 |
The TONI 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 |
|
$10.00
$30.00 |
96101 Modifier U9
96101 Modifier U2 |
No more than one (1) test from this category per evaluation. |
Evaluation of potential psychiatric illness malingering |
|
$20.00
$10.00 |
96101 Modifier UA
96101 Modifier U5 |
No more than one (1) test from this category per evaluation. |
Missed appointment |
|
$30.00 |
99199 |
This is not paid when the Contractor is providing services at a CSO and another DSHS Client is available.
This fee is only paid once per referral. |
This section details Aged, Blind, or Disabled (ABD) program medical evidence reimbursement rates. For a detailed service descriptions visit the Medical Evidence Reimbursements section of the ESA Social Services Manual.