Medicaid Behavioral Health Services: Psychiatric Services - Evaluation

2022

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 45; No - 0; NR - 6	Yes - 7	Yes - 11
Alabama	Yes	Yes - not specified	No
Alaska	Yes	No	4 per state fiscal year
Arizona	Yes	NR	No
Arkansas	NR	NR	NR
California	Yes	No	No
Colorado	Yes	No	No
Connecticut	Yes	No	No
Delaware	NR	NR	NR
District of Columbia	Yes	No	Service may be rendered without prior authorization once every 6 months, but prior authorization is required for more instances
Florida	Yes	$2	Limit of 2 psychiatric evaluations per state fiscal year
Georgia	NR	NR	NR
Hawaii	Yes	No	No
Idaho	Yes	No	No
Illinois	Yes	No	No
Indiana	Yes	No	Only eligible for one unit without prior authorization; prior authorization is required for more units
Iowa	Yes	No	No
Kansas	Yes	No	No
Kentucky	Yes	No	NR
Louisiana	Yes	No	NR
Maine	Yes	$.50 to $2 per day, depending on payment amount, up to $20 per month	No
Maryland	Yes	No	NR
Massachusetts	Yes	No	No
Michigan	Yes	No	No
Minnesota	NR	NR	NR
Mississippi	Yes	$3 for non-community mental health center outpatient setting	Limit of 1 per day and 4 per state fiscal year
Missouri	Yes	Yes - not specified	No
Montana	Yes	No	No
Nebraska	Yes	$2	No
Nevada	Yes	No	NR
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	Yes	No	No
North Carolina	Yes	No	Limit of 22 unmanaged visits per state fiscal year
North Dakota	Yes	No	No
Ohio	Yes	No	Prior authorization may be required after utilization thresholds
Oklahoma	Yes	$3	No
Oregon	Yes	No	No
Pennsylvania	Yes	No	No
Rhode Island	Yes	No	No
South Carolina	Yes	No	Limit of 1 encounter per 6 months
South Dakota	Yes	No	No
Tennessee	Yes	No	No
Texas	Yes	No	Limit of 1 per person, per rolling year for the same provider; limit may be exceeded with prior authorization
Utah	NR	NR	NR
Vermont	Yes	No	No
Virginia	Yes	No	No
Washington	Yes	No	Limit of 1 per client, per provider, per calendar year; no limit under rehab specialty mental health services
West Virginia	Yes	No	Based on medical necessity
Wisconsin	Yes	No	No
Wyoming	Yes	No	No

2018

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 46 No - 0 NR - 5	Yes - 10	Yes - 17
Alabama	Yes	No	5 per year
Alaska	Yes	No	No
Arizona	Yes	No	No
Arkansas	Yes	NR	NR
California	Yes	No	No
Colorado	Yes	No	No
Connecticut	Yes	No	Registration required 90 units in 12 months
Delaware	Yes	No	5 evaluations per year
District of Columbia	Yes	No	PA required for utilization of rehab assessments above certain benchmarks
Florida	Yes	$2.00 copayment per visit	Up to 2 evaluations per year.
Georgia	Yes	No	No
Hawaii	Yes	No	No
Idaho	Yes	No	Not covered in fee for service but may be covered by contracted outpatient behavioral health plan
Illinois	NR	NR	NR
Indiana	Yes	No	No
Iowa	NR	NR	NR
Kansas	Yes	$3.00 per visit	No
Kentucky	Yes	Co Pay $3	No
Louisiana	Yes	No	NR
Maine	Yes	$.50 to $2/day depending on payment amount, up to $20/month	No
Maryland	Yes	No	Services are pre-authorized
Massachusetts	Yes	No	No
Michigan	Yes	No	No
Minnesota	Yes	No	NR
Mississippi	Yes	No	Limited to 1 Daily, Maximum of 4 Yearly.
Missouri	Yes	$1 - $2	No
Montana	Yes	No	No
Nebraska	Yes	$2 copay	No
Nevada	Yes	No	Yes - Not Specified
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	NR	NR	NR
North Carolina	Yes	No	Prior authorization required for non-crisis related evaluation after 8 visits; prior authorization required for Psychotherapy for Crisis and Psychological Testing beyond the unmanaged visit limit
North Dakota	Yes	$2 per visit	1 evaluation per year all reevaluations require authorization
Ohio	Yes	No	1 encounter per person per calendar year per billing agency per code (90791, 90792) per year. Prior authorization once limit is reached.
Oklahoma	Yes	$4 per visit	Must be completed within 60 hours of admission by an allopathic or osteopathic physician with a current license and a board certification/eligible in psychiatry
Oregon	Yes	No	No
Pennsylvania	Yes	No	No
Rhode Island	Yes	No	No
South Carolina	NR	NR	NR
South Dakota	Yes	$3/visit	NR
Tennessee	Yes	No	No
Texas	Yes	No	One per year without prior authorization
Utah	Yes	No	No
Vermont	Yes	No	No
Virginia	Yes	No	No
Washington	Yes	No	Some require prior authorization
West Virginia	Yes	No	PA Required
Wisconsin	Yes	$0.50-$3.00 per service	No
Wyoming	Yes	No	Prior authorization is required after the first 20 visits to confirm ongoing medical necessity

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Medicaid Behavioral Health Services: Psychiatric Services – Evaluation

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Medicaid Behavioral Health Services: Psychiatric Services – Evaluation

2022

2018

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