Is this a fee-for-service Medical Assistance benefit or a benefit within Prepaid Medical Assistance Programs (PMAP)?

This is a benefit for children enrolled in all Minnesota Health Care Programs (MHCP), including Medical Assistance fee-for-service and PMAP, as well as MinnesotaCare.

Will it be necessary to bill primary insurance for denial before billing to MHCP?

Yes. You must first bill the service to the primary insurance.

Can we bill retroactively?

Yes. You may bill for this service back to January 1, 2015, as long as the coverage criteria are met. You may bill retroactively only for a data of service on which you have existing progress note documentation. You cannot create documentation now, for a service provided in the past.

If I provided family psychoeducation in March 2015 but I did not document it because I didn't expect to get paid, can I document it now in December and bill retroactively?

No. You must document family psychoeducation when you provided it. Only providers who provide family psychoeducation to an eligible recipient and document family psychoeducation according to requirements on the date of service may bill retroactively.

Can I bill family psychoeducation on the same day as psychotherapy?

Currently yes, but check for National Correct Coding Initiative (NCCI) Edits using the Centers for Medicare and Medicaid Services (CMS) website. Both family psychoeducation and psychotherapy must be included in the recipient's individual treatment plan.

Centers for Medicare and Medicaid Services (CMS)

Can I bill family psychoeducation on the same day I bill for a mental health diagnostic assessment?

Yes. Currently you may bill family psychoeducation and diagnostic assessment on the same day. However, check for NCCI Edits using the Centers for Medicare and Medicaid Services (CMS) website.

Centers for Medicare and Medicaid Services (CMS)

How is the provision of family psychoeducation counted towards the authorization limit, especially for family, group, and multiple family group psychoeducation?

For individual psychoeducation, each 15 minute unit counts as one unit toward the psychotherapy benefit limit. For example, bill one hour of individual psychoeducation as four units toward the benefit limit.

For group, family or multiple family psychoeducation, each date of service, regardless of the number of units billed, counts as one unit toward the corresponding group psychotherapy benefit limit. For example, you would bill one hour of any of these group psychoeducation types as four 15-minute units. This one hour counts as four units toward the benefit limit.

What documentation does the medical record need to contain to verify delivery of family psychoeducation?

The record must contain the items identified in the MHCP Provider Manual under Documentation - Progress Notes.

Are psychoeducation services in Children's Therapeutic Services and Supports (CTSS)?

No. These services exist as outpatient services and cannot be billed as a service under CTSS using the UA Modifier. You may provide these services to all children, regardless of whether they are receiving CTSS rehabilitative services or outpatient mental health services.

How is psychoeducation different than psychotherapy?

The primary purpose of family psychoeducation is to educate and inform individuals and their caregivers about aspects of mental illness, treatment, and recovery. Psychotherapy, on the other hand, consists of a series of therapeutic interventions and is a process directly treating the symptoms of mental illness. Psychoeducation is a distinct evidence based service with its own HCPCS (Healthcare Common Procedure Coding System) Code.

If the family member is not on the child's health plan, can he or she participate in the family psychoeducation?

Yes. Remember that family members' participation is identified in the individual treatment plan as important to the treatment of the child.

Can this benefit be used for general parent education?

No, this is not general parent education. These are services that are identified as needed to treat a child in the individual treatment plan, with specific goals and interventions listed.

Do treatment goals and objectives for family psychoeducation need to be different from those for psychotherapy if provided on the same day?

No, treatment objectives and goals could be the same with different treatment modalities. The treatment plan must indicate for each objective why both the modalities are medically necessary and how they are helping the client meet those treatment objectives.

Do I bill psychoeducation only in conjunction with evidence based practices (EBPs)?

No. Although psychoeducation is identified as an EBP, it does not have to be billed only in the context of other EBP service provision.

Is one session of family psychoeducation available prior to finishing the diagnostic assessment, like what is permitted psychotherapy?

No, psychoeducation service is not available or covered prior to completing a diagnostic assessment.

How are you counting families for the multiple family group modality of psychoeducation?

A family group may be two to 10 families. The groups must be conducted as follows:

• A family group must be at least two but no more than 10 families. At least one mental health professional or clinical trainee is required to conduct a group with two to five families.
• For a group of six to 10 families, any combination of at least two mental health professionals or clinical trainees is required to co-conduct the group.
• Submit claims only for the recipient who is the primary subject of the family psychoeducation sessions, regardless of the number of other family or group members in the session.
• When more than one family member is a recipient (such as two or three siblings, each receiving treatment within a specific timeframe), bill only for the time spent conducting family psychoeducation with each recipient.