Limitations on Outpatient Mental Health Services

Date: 11/01/18

The Indiana Health Coverage Programs Mental Health and Addiction Provider Reference Module (May 2017) outlines a coverage policy for the following CPT [1] codes that, in combination, are limited 20 units per member, per provider, per rolling 12-month period:

Code	Description
90832 - 90834	Individual Psychotherapy
90836 - 90840	Psychotherapy, with patient and/or family member & Crisis Psychotherapy
90845 - 90853	Psychoanalysis & Family/Group Psychotherapy with or without patient
90899	Unlisted psychiatric service

Effective 12/15/18, Managed Health Services (MHS) will apply the limitations for claims with dates of service (DOS) on or after 12/15/18. Claims exceeding the limit will deny EX Wb: Maximum Benefit Exceeded.

If the member requires additional services above the 20 unit limitation, providers may request prior authorization for additional units.  Approval will be given based on the necessity of the services as determined by the review of medical records. Providers will need to determine if they have provided 20 units to the member in the past rolling 12 months to determine if a prior authorization request is needed. 

For more information on the IHCP policy, please review the Provider Reference Module and BR201809.