Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1153 - OUTPATIENT PSYCHIATRIC SERVICES
PAYMENT FOR OUTPATIENT BEHAVIORAL HEALTH SERVICES
Section 1153.53 - Limitations on payment
Current through Register Vol. 54, No. 12, March 23, 2024
Payment is subject to the following limitations:
(1) Psychiatric partial hospitalization outpatient service is provided for at least 3 hours per 24-hour period.
(2) The partial hospitalization outpatient service fees listed in the MA Program Fee Schedule include payment for all services rendered to the individual during a psychiatric partial hospitalization outpatient session. Separate billings for individual services are not compensable.
(3) Partial hospitalization outpatient facilities licensed for adult programs will be reimbursed at the adult rate, regardless of the age of the individual receiving treatment.
(4) Partial hospitalization outpatient facilities licensed as children and youth programs will be reimbursed at the child rate only when the individual receiving treatment is under 15 years of age.
(5) Family psychotherapy and collateral family psychotherapy are compensable for only one person per session, regardless of the number of family members who participate in the session or the number of participants who are eligible for psychotherapy.
(6) MMHT group therapy shall be provided only in an approved community-based site as specified in the treatment plan to individuals receiving MMHT services from the psychiatric outpatient clinic.
The provisions of this § 1153.53 amended under sections 201(2), 403(b), 443.1, 443.3, 443.6, 448 and 454 of the Human Services Code (62 P. S. §§ 201(2), 403(b), 443.1, 443.3, 443.6, 448 and 454).
