Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA 02111 www.mass.gov/dma

MASSHEALTH
TRANSMITTAL LETTER PSY-20
September 2003
TO:      Psychologists Participating in MassHealth
FROM:      Douglas S. Brown, Acting Commissioner
RE:      Psychologist Manual (Revised Regulations and Service Codes)
This letter transmits revisions to the MassHealth psychologist program regulations and Subchapter 6, Service Codes and Descriptions, of the Psychologist Manual. These revisions are effective October 1, 2003.
Revised Regulations
The Division has revised the psychologist regulations to comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
The revisions also update terminology and remove provisions that are duplicated in the administrative and billing regulations at 130 CMR 450.000. The Division has also increased the recordkeeping requirement from four to six years, to be consistent with the administrative and billing regulations at 130 CMR 450.205.
In addition, the Division has deleted 130 CMR 411.421, which described other reimbursable mental health services. This section was outdated, and was for information only. Psychologists who want to know the full scope of mental health services available from other types of mental health providers may review the applicable MassHealth regulations. All of the MassHealth regulations are available on the Division’s Web site at www.mass.gov/dma.
Revised Subchapter 6
This letter also transmits revisions to the list of MassHealth-covered service codes and descriptions in Subchapter 6 of the Psychologist Manual. These revisions are effective for dates of service on or after October 1, 2003. 2003 Healthcare Common Procedure Coding System (HCPCS) codes have been added to replace MassHealth local codes. The local codes have been replaced so that the Division’s coding requirements are compliant with HIPAA.

MASSHEALTH
TRANSMITTAL LETTER PSY-20 September 2003 Page 2
Billing Guidelines
Effective for dates of service beginning October 1, 2003, providers may use only those codes listed in the attached Subchapter 6. A crosswalk table, listing the old service codes and descriptions and the new HIPAA-compliant ones, is also attached.
For dates of service before October 1, 2003, providers must use the local codes, even if the claim is submitted on or after October 1, 2003.
Consolidation of Service Codes
Providers will notice that the following psychological tests are now represented by Service Code 96100. The Division expects that upon utilization review, the majority of these tests would be found to have been completed within the following timeframes:
Vocational Interest Evaluation	1 hour
Educational Achievement Testing	1 hour
Intelligence Testing	1-2 hours
Personality Evaluation	2-4 hours
Assessment of Brain Damage	2-4 hours
Intellectual & Personality Evaluation	3-6 hours
How to Obtain a Psychological Services Fee Schedule with the New Service Codes
Providers who want to obtain a fee schedule with the new service codes may purchase Division of Health Care Finance and Policy regulations from either the Massachusetts Bookstore or from the Division of Health Care Finance and Policy (see addresses and telephone numbers below). Providers must contact them first to find out the price of the publication. The Division of Health Care Finance and Policy also has the regulations on disk and on their Web site. The regulation title is 114.3 CMR 29.00: Psychological Services.
Massachusetts State Bookstore	Division of Health Care Finance and Policy
State House, Room 116	Two Boylston Street
Boston, MA 02133	Boston, MA 02116
Telephone: 617-727-2834	Telephone: 617-988-3100
www.mass.gov/sec/spr	www.mass.gov/dhcfp

MASSHEALTH
TRANSMITTAL LETTER PSY-20 September 2003 Page 3
Web Site Access and Questions
This transmittal letter and the revised regulations are available on the Division’s Web site at www.mass.gov/dma.
If you have any questions, please call MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.
Effective Date
The regulations and revised Subchapter 6 are effective October 1, 2003.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Psychologist Manual
Pages iv, vi, vii, 4-1 through 4-8, 6-1, and 6-2
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Psychologist Manual
Pages iv and 4-3 through 4-10 — transmitted by Transmittal Letter PSY-17
Page vi — transmitted by Transmittal Letter PSY-18
Pages vii and viii — transmitted by Transmittal Letter PSY-1
Pages 4-1 and 4-2 — transmitted by Transmittal Letter PSY-19
Page 6-1 — transmitted by Transmittal Letter PSY-15

Transmittal Letter PSY-20
October 2003
Attachment
Page 1
Psychologist Provider Service Code Crosswalk
Obsolete       Obsolete Code Description	New	New Code Description	Additional Description and/or Unit
Code	Code

X9160	Vocational-interest evaluation (normally including, but not limited to, the Strong Campbell Interest Inventory or the Kuder Preference Record)	96100	Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour	The Division expects that upon utilization review, the majority of psychological testing billed under the new national code of 96100 would be found to have been completed within the following timeframes:
Vocational Interest Evaluation 1 hour Educational Achievement Testing 1 hour Intelligence Testing 1-2 hours Personality Evaluation 2-4 hours Assessment of Brain Damage 2-4 hours Intellectual & Personality Evaluation 3-6 hours	
X9161	Educational-achievement testing (normally including, but not limited to, the Jastak Wide Range or Peabody Individual Achievement Tests)	96100	Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour	The Division expects that upon utilization review, the majority of psychological testing billed under the new national code of 96100 would be found to have been completed within the following timeframes:
Vocational Interest Evaluation 1 hour Educational Achievement Testing 1 hour Intelligence Testing 1-2 hours Personality Evaluation 2-4 hours Assessment of Brain Damage 2-4 hours Intellectual & Personality Evaluation 3-6 hours	
X9162	Intelligence testing only (including with either the Wechsler Intelligence Scales or the Stanford Binet Intelligence Scale, which must be individually administered)	96100	Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour	The Division expects that upon utilization review, the majority of psychological testing billed under the new national code of 96100 would be found to have been completed within the following timeframes:
Vocational Interest Evaluation 1 hour Educational Achievement Testing 1 hour Intelligence Testing 1-2 hours Personality Evaluation 2-4 hours Assessment of Brain Damage 2-4 hours Intellectual & Personality Evaluation 3-6 hours	
X9163	Personality evaluation (including at least: two or more of the following types of tests or their age-appropriate equivalents: Rorschach, TAT Thematic Apperception Test, TED Tasks of Emotional Development, MMPI Minnesota Multiphasic Personality Inventory; and one or more types of tests from the following group, normally including, but not limited to, figure drawing, Bender Gestalt or word association.	96100	Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour	The Division expects that upon utilization review, the majority of psychological testing billed under the new national code of 96100 would be found to have been completed within the following timeframes:
Vocational Interest Evaluation 1 hour Educational Achievement Testing 1 hour Intelligence Testing 1-2 hours Personality Evaluation 2-4 hours Assessment of Brain Damage 2-4 hours Intellectual & Personality Evaluation 3-6 hours	
X9164	Intellectual and personality evaluation (including, but not limited to, the tests listed under Service Codes X9162 and X9163	96100	Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour	The Division expects that upon utilization review, the majority of psychological testing billed under the new national code of 96100 would be found to have been completed within the following timeframes:
Vocational Interest Evaluation 1 hour Educational Achievement Testing 1 hour Intelligence Testing 1-2 hours Personality Evaluation 2-4 hours Assessment of Brain Damage 2-4 hours Intellectual & Personality Evaluation 3-6 hours	

Transmittal Letter PSY-20
October 2003
Attachment
Page 2
Psychologist Provider Service Code Crosswalk
Obsolete       Obsolete Code Description	New	New Code Description	Additional Description and/or Unit
Code	Code

X9165	Assessment of brain damage (normally including, but not limited to, the Wechsler Intelligence Scales and standardized tests of memory such as the Wechsler Memory Scales and the Benton Visual Retention Test)	96100	Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour	The Division expects that upon utilization review, the majority of psychological testing billed under the new national code of 96100 would be found to have been completed within the following timeframes:
Vocational Interest Evaluation 1 hour Educational Achievement Testing 1 hour Intelligence Testing 1-2 hours Personality Evaluation 2-4 hours Assessment of Brain Damage 2-4 hours Intellectual & Personality Evaluation 3-6 hours	
X9167	Unlisted service (including such services as abbreviated or “quick” intelligence tests or a separately administered Rorschach test)	96100	Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour	The Division expects that upon utilization review, the majority of psychological testing billed under the new national code of 96100 would be found to have been completed within the following timeframes:
Vocational Interest Evaluation 1 hour Educational Achievement Testing 1 hour Intelligence Testing 1-2 hours Personality Evaluation 2-4 hours Assessment of Brain Damage 2-4 hours Intellectual & Personality Evaluation 3-6 hours	
X9166	Neuropsychological examination (assessment of brain damage including the Halstead-Reitan or Luria-Nebraska Neuropsychological Battery or other battery of comparable scope or intensity)	96117	Neuropsychological testing battery (e.g., Halstead-Reitan, Luria, WAIS-R) with interpretation and report, per hour		

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
TABLE OF CONTENTS	PAGE
iv	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
4.   PROGRAM REGULATIONS
411.401: Introduction 		4-1
411.402: Definitions 		4-1
411.403: Eligible Members 		4-1
411.404: Provider Eligibility 		4-2
411.405: Payable Services 		4-2
411.406: Nonpayable Services 		4-2
411.407: Nonpayable Circumstances 		4-2
411.408: Maximum Allowable Fees 		4-3
(130 CMR 411.409 Reserved)
411.410: Referral 		4-4
(130 CMR 411.411 Reserved)
411.412: Procedures for Psychological Testing 		4-5
411.413: Recordkeeping Requirements 		4-5
411.414: Service Limitations 		4-6

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
TABLE OF CONTENTS	PAGE
vi	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
6.   SERVICE CODES AND DESCRIPTIONS
Psychological Testing 		6-1
Appendix A. DIRECTORY 		A-1
Appendix B. ENROLLMENT CENTERS 		B-1
Appendix C. THIRD-PARTY-LIABILITY CODES 		C-1
Appendix D. MENTAL HEALTH/SUBSTANCE ABUSE PROGRAM 		D-1
Appendix W. EPSDT SERVICES: MEDICAL PROTOCOL AND
PERIODICITY SCHEDULE 		W-1
Appendix X. FAMILY ASSISTANCE COPAYMENTS AND DEDUCTIBLES 		X-1
Appendix Y. REVS/CODES MESSAGES 		Y-1
Appendix Z. EPSDT SERVICES LABORATORY CODES 		Z-1

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
PREFACE	PAGE
vii	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
The regulations and instructions of the Division of Medical Assistance governing provider participation in MassHealth are published in the Provider Manual Series. The Division publishes a separate manual for each provider type.
Each manual in the series contains administrative regulations, billing regulations, program regulations, service codes and descriptions, billing instructions, and general information. The Division's regulations are incorporated into the Code of Massachusetts Regulations (CMR), a collection of regulations promulgated by state agencies within the Commonwealth and by the Secretary of State. Regulations promulgated by the Division of Medical Assistance are assigned Title 130 of the Code. The regulations governing provider participation in MassHealth are assigned Chapters 400 through 499 within Title 130. Pages that contain regulatory material have a CMR chapter number in the banner beneath the subchapter number and title.
Administrative regulations and billing regulations apply to all providers and are contained in 130 CMR Chapter 450.000. These regulations are reproduced as Subchapters 1, 2, and 3 in this and all other manuals.
Program regulations cover matters that apply specifically to the type of provider for which the manual was prepared. For psychologist services, those matters are covered in 130 CMR Chapter 411.000, reproduced as Subchapter 4 in the Psychologist Manual.
Revisions and additions to the manual are made as needed by means of transmittal letters, which furnish instructions for making changes by hand ("pen-and-ink" revisions), and by substituting, adding, or removing pages. Some transmittal letters will be directed to all providers; others will be addressed to providers in specific provider types. In this way, a provider will receive all those transmittal letters that affect its manual, but no others.
The Provider Manual Series is intended for the convenience of providers. Neither this nor any other manual can or should contain every federal and state law and regulation that might affect a provider's participation in MassHealth. The provider manuals represent instead the Division's effort to give each provider a single convenient source for the essential information providers need in their routine interaction with the Division and with MassHealth members.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 411.000)	PAGE
4-1	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
411.401: Introduction
All psychologists participating in MassHealth must comply with the regulations of the Division governing MassHealth, including but not limited to Division regulations set forth in 130 CMR 411.000 and 450.000.   The Division pays psychologists for psychological testing only.
411.402: Definitions
The following terms used in 130 CMR 411.000 have the meanings given in 130 CMR 411.402, unless the context clearly requires a different meaning.
Diagnostic Service — the examination and determination by interview techniques of a member's physical, psychological, social, economic, educational, and vocational capabilities and disabilities for the purposes of developing a diagnostic formulation and designing a treatment plan.
Psychological Testing — the use of standardized test instruments to evaluate aspects of a member's functioning, including aptitudes, educational achievements, cognitive processes, emotional conflicts, and type and degree of psychopathology.
Treatment Service — a service related to diminishing the distress and symptoms of mental and emotional disorders, and including, but not limited to, chemotherapy and individual, couple, family, and group psychotherapy.
411.403: Eligible Members
(A)	(1) MassHealth Members. The Division covers psychologist services only when provided to
eligible MassHealth members, subject to the restrictions and limitations described in 130
CMR 411.000 and 450.000. The Division’s regulations at 130 CMR 450.105 specifically
state, for each MassHealth coverage type, which services are covered and which members are
eligible to receive those services.
(2) Recipients of the Emergency Aid to the Elderly, Disabled and Children Program. For information on covered services for recipients of the Emergency Aid to the Elderly, Disabled and Children (EAEDC) Program, see 130 CMR 450.106.
(B)	For information on verifying member eligibility and coverage type, see 130 CMR 450.107.
(C)	See 130 CMR 450.124 for limitations on mental health and substance abuse services
provided to members enrolled with a MassHealth managed care provider.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 411.000)	PAGE
4-2	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
411.404: Provider Eligibility
Payment for the services described in 130 CMR 411.000 is made only to providers who are participating in MassHealth as of the date of service. The eligibility requirements are as follows.
(A)	In State. A psychologist is eligible to participate in MassHealth only if the psychologist is licensed to practice by the Massachusetts Board of Registration of Psychologists, with a specialization listed in clinical or counseling psychology or a closely related specialty, and is a Medicare provider.
(B)	Out of State. A psychologist located outside of Massachusetts is eligible to participate in MassHealth only if the psychologist is licensed to practice by his or her state's appropriate board of registration, and is a Medicare provider.
411.405: Payable Services
(A)	The Division pays for psychological testing personally provided by a licensed psychologist, subject to the restrictions and limitations in 130 CMR 411.000.
(B)	The psychologist may provide psychological testing services in any suitable location, such as the psychologist's office, the member's place of residence, or other facility.
411.406: Nonpayable Services
The Division does not pay a psychologist for diagnostic (other than by testing) or treatment services, including services the psychologist performs when working under the supervision of a psychiatrist or when responding to a referral from a psychiatrist.
411.407: Nonpayable Circumstances
The Division does not pay a psychologist for services provided under any of the following circumstances.
(A)	The psychologist provided the service in a facility approved by MassHealth and is paid by the facility to provide that service, whether or not the cost of the service is included in the Division's rate of payment for that facility.
(B)	The psychologist provided the service in a facility that is organized to provide primarily nonmedical services and is paid by the facility to provide the service.
(C)	The psychologist has received payment for services for which the psychologist has already received payment from the Commonwealth, county, or municipality.
(D) Under comparable circumstances, the psychologist does not customarily bill patients who do not have health insurance.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 411.000)	PAGE
4-3	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
411.408: Maximum Allowable Fees
The Massachusetts Division of Health Care Finance and Policy determines the maximum allowable fees for psychological testing. The fees include payment for the complete cost of interviewing and testing the member, scoring the test, interpreting the results, and writing the report. Payment is always subject to the conditions, exclusions, and limitations set forth in 130 CMR 411.000 and 450.000. Payment for a service is made at the lower of the following:
(A)	the psychologist's usual and customary charge to the general public for the same or similar service; or
(B)	the maximum allowable fee listed in the applicable Division of Health Care Finance and Policy fee schedule.
(130 CMR 411.409 Reserved)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 411.000)	PAGE
4-4	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
411.410: Referral
The Division pays a psychologist for psychological testing only if an agency or individual responsible for providing services to the member requests them, or if a physician or community health center requests them for the purposes of determining or redetermining eligibility for the EAEDC Program pursuant to 130 CMR 450.106. This ensures that the service is provided within the context of an overall service plan. Such agencies or individuals may include physicians, psychologists, other psychotherapists, clinics, day habilitation centers, intermediate care facilities for the mentally retarded, hospitals, schools, courts, group homes, or state agencies. The Division may deny or recover payment if the psychologist fails to provide to the Division, when requested, documented evidence that psychological testing was requested and actually provided.
(130 CMR 411.411 Reserved)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 411.000)	PAGE
4-5	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
411.412: Procedures for Psychological Testing
As a prerequisite to payment, the psychologist must:
(A) interact directly with the member during testing, with the exception noted in 130 CMR 411.414(G);
(B)	personally administer and score the test, with the exception noted in 130 CMR 411.414(G);
(C)	personally evaluate the responses to the test;
(D)	write a report of the evaluation results in a manner that communicates useful information to the individual or agency requesting such testing; and
(E)	forward a copy of the comprehensive report to the referring individual or agency without
additional charge to the Division, requesting individual or agency, or member.
411.413: Recordkeeping Requirements
(A)	Payment for any service listed in 130 CMR 411.000 is conditioned upon its full and complete
documentation in the member's medical record. The psychologist must maintain a record (chart or
folder) of all psychology services provided to a member for a period of at least six years following
the date of service. The record must be identified by the name of the member and the date or dates
of testing. The record must contain the following information:
(1)	the referral source;
(2)	the reason for the referral;
(3)	for a personality evaluation or an assessment of organic mental disorders, a brief description of behavioral observations, and any other personal information elicited during testing;
(4)	the protocol of responses to the tests used;
(5)	a summary of scores; and
(6)	a comprehensive written report describing the psychological evaluation and interpretation of responses.
(B)	Release of information in the record is limited to the following:
(1)	those instances required by federal or state statute or regulation in accordance with the confidentiality provisions of the profession; and
(2)	qualified personnel or consultants of the Department or the U.S. Department of Health and Human Services for the purpose of monitoring the provision of services in accordance with 130 CMR 411.000.
(1)	
Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 411.000)	PAGE
4-6	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
411.414: Service Limitations
(A)	Frequency of Psychological Testing. The Division does not pay for a psychological test if the
psychologist has provided that test to the member within the preceding six months, unless the
psychologist attaches a report to the claim documenting the presence of one of the conditions
listed below. In the cases of 130 CMR 411.414(A)(1) or (2), the Division pays for only one
repetition of the same test in a six-month period.
(1)	The purpose of testing is to ascertain changes in the member following such special forms of treatment or intervention as electroconvulsive therapy or psychiatric hospitalization. Testing on a regular basis (for example, once monthly) to measure response to psychotherapy is not payable.
(2)	The purpose of testing is to ascertain changes relating to suicidal, homicidal, toxic, traumatic, or neurological conditions.
(B)	Selection of Psychological Tests. The psychologist must determine the specific tests to
administer, provided that the selection reflects a scope and intensity consistent with the
requirements in 130 CMR 411.414(B)(1) and (2) and in 130 CMR 411.414(C) through (G).
(1)	The tests must be published, valid, and in general use, as defined by listing in the Mental Measurement Yearbook, edited by Oscar Krisen Buros, or by conformity to the Standards for Educational and Psychological Tests of the American Psychological Association.
(2)	The Division does not pay a psychologist for self-rating forms and other paper-and-pencil instruments, unless they are administered as part of a comprehensive battery of tests. Only the self-rating forms listed in 130 CMR 411.414(C) through (G) are payable for purposes of evaluation.

(C)	Intelligence Testing Only. Unless clinically contraindicated due to hearing, physical, or visual impairment or linguistic challenges, intelligence testing must include either a full Wechsler or Stanford-Binet scale. Group forms of intelligence tests are not payable.
(D)	Personality Evaluation Only. A personality evaluation must consist of a battery of techniques in order to yield an adequate assessment of personality. Unless clinically contraindicated due to hearing, physical, or visual impairment or linguistic challenges, a record for a personality evaluation must contain the findings of at least two of the following types of tests or their age-appropriate equivalents: Rorschach, TAT (Thematic Apperception Test), TED (Tasks of Emotional Development), or MMPI (Minnesota Multiphasic Personality Inventory); and one or more of the following types of tests or their equivalents: figure drawing, Bender Gestalt, or word association.
(E)	Intellectual and Personality Evaluation. An intellectual and personality evaluation must
consist of a battery of procedures selected in accordance with the requirements in 130 CMR
411.414(B) through (D).
(1)	The Division does not pay a psychologist for a comprehensive intellectual and personality evaluation if the psychologist has provided intelligence testing only or a personality evaluation only to the member within the preceding six months.
(2)	The Division does not pay a psychologist for intelligence testing only or a personality evaluation only if the same psychologist has provided a comprehensive intellectual and personality evaluation to the member within the preceding six months.
(1)	
Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 411.000)	PAGE
4-7	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
(3) The Division will waive the restrictions in 130 CMR 411.414(E)(1) and (2) if the psychologist attaches a report to the claim documenting the presence of one of the conditions described in 130 CMR 411.414(A)(1) or (2).
(F)	Assessment of Brain Damage. Assessment of brain damage must consist of a battery of
procedures in order to determine if a member is organically impaired. Unless clinically
contraindicated due to hearing, physical, or visual impairment or linguistic challenges, a record for
assessment of brain damage must contain the findings of a Wechsler Intelligence Scale and tests of
recent memory, visual-space perception, and other functions commonly associated with brain
damage.
(G)	Neuropsychological Examination. Payment for the use of the Halstead-Reitan or
Luria-Nebraska battery must be claimed under the service code for a neuropsychological
examination if the battery is administered as the primary procedure to assess the presence of brain
damage.
(1)	The psychologist must submit a written report with the claim. This report must be sufficiently detailed to enable the Division to assess the extent and nature of the psychological test.
(2)	The psychologist is eligible to receive payment for the neuropsychological examination when a technician administers and scores it only if:

(a)	the technician is trained to perform the tests;
(b)	the psychologist selects the specific tests to be included in the battery;
(c)	the technician performs the tests under the direct, personal, and continuous supervision of the psychologist who must assume professional responsibility for the tests provided; and
(d)	the psychologist personally interprets the tests and writes the evaluation report.
(3)	The psychologist must claim an assessment of brain damage as a separate psychological
testing service when it is administered as part of the preliminary screening for a
neuropsychological examination.
REGULATORY AUTHORITY
130 CMR 411.000: M.G.L. c. 118E, §§7 and 12

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 411.000)	PAGE
4-8	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
This page is reserved.

Commonwealth of Massachusetts
Medical Assistance Program
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-1	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
601   Psychological Testing
Service
Code       Service Description
96100      Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour
96117     Neuropsychological testing battery (e.g., Halstead-Reitan, Luria, WAIS-R) with interpretation and report, per hour
This publication contains codes that are copyrighted by the American Medical Association. Certain terms used in the service descriptions for HCPCS codes are defined in the Current Procedural Terminology (CPT) code book.

Commonwealth of Massachusetts
Medical Assistance Program
Provider Manual Series
PSYCHOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-2	

	TRANSMITTAL LETTER
PSY-20	DATE
10/01/03	
This page is reserved.