Sec. 10.21.25.05. Fee Schedule — Treatment Services — Diagnosis and Therapy

A. Diagnostic Interview. The Department shall reimburse a provider for a face-to-face diagnostic interview, as follows:

(1) For a child or adolescent, when rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:

(a) OMHC ... $190.23;

(b) Physician ... $151.68;

(c) Psychologist ... $121.08;

(d) Other mental health professionals ... $106.01;

(2) For an adult:

(a) OMHC ... $170.32;

(b) Physician ... $151.68;

(c) Psychologist ... $121.08;

(d) Other mental health professional ... $106.01.

B. Individual Therapy. The Department shall reimburse a provider for an individual therapy session, as follows:

(1) For a child or adolescent, when rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:

(a) For 30 minutes:

(i) OMHC ... $59.19;

(ii) Physician ... $50.05;

(iii) Psychologist ... $40.09;

(iv) Other mental health professional ... $34.98;

(b) For 20-30 minutes, with biofeedback training:

(i) OMHC ... $50.05;

(ii) Physician ... $50.05;

(iii) Psychologist ... $40.09;

(iv) Other mental health professional ... $34.98;

(c) For 45 minutes:

(i) OMHC ... $105.20;

(ii) Physician ... $90.94;

(iii) Psychologist ... $72.65;

(iv) Other mental health professional ... $63.77;

(d) For 45-50 minutes, with biofeedback training:

(i) OMHC ... $90.94;

(ii) Physician ... $90.94;

(iii) Psychologist ... $72.65;

(iv) Other mental health professional ... $63.77;

(e) For 60 minutes in an OMHC ... $105.20;

(2) For an adult:

(a) For 30 minutes:

(i) OMHC ... $50.05;

(ii) Physician ... $50.05;

(iii) Psychologist ... $40.09;

(iv) Other mental health professional ... $34.98;

(b) For 20-30 minutes, with biofeedback training:

(i) OMHC ... $50.05;

(ii) Physician ... $50.05;

(iii) Psychologist ... $40.09;

(iv) Other mental health professional ... $34.98;

(c) For 45 minutes:

(i) OMHC ... $90.94;

(ii) Physician ... $90.94;

(iii) Psychologist ... $72.65;

(iv) Other mental health professional ... $63.77;

(d) For 45-50 minutes, with biofeedback training:

(i) OMHC ... $90.94;

(ii) Physician ... $90.94;

(iii) Psychologist ... $72.65;

(iv) Other mental health professional ... $63.77;

(e) For 60 minutes in an OMHC ... $90.94.

C. Family Therapy. The Department shall reimburse a provider for a family therapy session, as follows:

(1) When the identified patient is a child or adolescent and the service is rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:

(a) Without the identified patient:

(i) OMHC ... $104.13;

(ii) Physician ... $85.02;

(iii) Psychologist ... $69.96;

(iv) Other mental health professional ... $53.81;

(b) With the identified patient, for 20-30 minutes:

(i) OMHC ... $58.65;

(ii) Physician ... $58.65;

(iii) Psychologist ... $46.82;

(iv) Other mental health professional ... $41.17;

(c) With the identified patient, for 45-60 minutes:

(i) OMHC ... $107.62;

(ii) Physician ... $94.71;

(iii) Psychologist ... $76.41;

(iv) Other mental health professional ... $65.64;

(2) When the identified patient is an adult:

(a) Without the identified patient for 45-60:

(i) OMHC ... $90.14;

(ii) Physician ... $85.02;

(iii) Psychologist ... $69.96;

(iv) Other mental health professional ... $53.81;

(b) With the identified patient, for 45-60 minutes:

(i) OMHC ... $94.71;

(ii) Physician ... $94.71;

(iii) Psychologist ... $76.41;

(iv) Other mental health professional ... $65.64.

D. Group Therapy. The Department shall reimburse a provider for each individual, up to a maximum of 10, in a group therapy session as follows:

(1) When the identified patient is a child or adolescent and the service is rendered by a provider with demonstrated competency to provide mental health services to children or adolescents:

(a) For 45-60 minutes:

(i) OMHC ... $40.90;

(ii) Physician ... $24.75;

(iii) Psychologist ... $24.75;

(iv) Other mental health professional ... $24.75;

(b) For more than 75 minutes in an OMHC ... $50.58;

(2) When the identified patient is an adult:

(a) For 45-60 minutes:

(i) OMHC ... $38.74;

(ii) Physician ... $24.75;

(iii) Psychologist ... $24.75;

(iv) Other mental health professional ... $24.75;

(b) For more than 75 minutes in an OMHC ... $50.58.