Outpatient Psychiatric Hospital Services

Outpatient psychiatric hospital services and supplies must:

  • Be medically reasonable and necessary for purpose of diagnostic study or reasonably be expected to improve patient's condition. For every service that is billed, provider must indicate the specific sign, symptom, or patient complaint necessitating the service. Medically necessary services and supplies:
    • Are proper and needed for diagnosis or treatment of beneficiary's medical condition;
    • Are furnished for diagnosis, direct care, an treatment of beneficiary's medical condition;
    • Meet standards of good medical practice and are not mainly for the convenience of beneficiary, provider, or supplier;
  • Be furnished under an individualized written plan of care (POC) that states:
    • Type, amount, frequency, and duration of services to be furnished;
    • Diagnosis; and
    • Anticipated goals (except when only a few brief services are furnished);
  • Be supervised and periodically evaluated by a physician who:
    • Prescribes the services;
    • Determines extent to which treatment goals have been reached and whether changes in direction or emphasis are needed;
    • Provides supervision and direction to therapists involved in patient's treatment; and
    • Documents his/her involvement in patient's medical record; and
  • Be for purpose of diagnostic study or, at a minimum, designed to reduce or control patient's  psychiatric symptoms so as to prevent a relapse or hospitalization and improve or maintain patient's level of functioning

Last Updated May 07, 2018