Mental Incapacity Evaluation Services
Revised on: May 29, 2024
Reimbursement for psychological evaluations and testing is limited to the terms and conditions outlined in the Community Services Division (CSD) Mental Incapacity Evaluation (MIE) contract.
For information about this contract, visit the CSD Mental Incapacity Evaluations contract procurement page.
MIE Contractors must enroll in ProviderOne to claim reimbursement for these services. Visit the Health Care Authority’s Provider Enrollment page for additional information.
For TANF or RCA related claims the contractor must contact the CSO contact for reimbursement.
Medical Evidence Fee Schedule
For a detailed service description of the clinical psychological/psychiatric evaluation, visit the Medical Evidence Requirements and Reimbursements section of the ESA Social Services Manual.
|
Service Type |
Service Description |
Reimbursement Fee |
ProviderOne Service Code |
Additional Conditions |
|---|---|---|---|---|
|
Clinical evaluation |
When performed by a licensed/contracted psychologist (Taxonomy: 103T00000X) |
$180.00 |
96156 Modifier 25 |
Must be an acceptable complete report as described in Exhibit B, Statement of Work |
|
Clinical evaluation |
When performed by a licensed/contracted psychiatrist (Taxonomy: 2084P0800X) |
$200.00 |
90791 |
Must be an acceptable complete report as described in Exhibit B, Statement of Work |
|
Clinical evaluation |
When performed by a licensed/contracted advanced registered nurse practitioner (ARNP) for impairments within their licensed scope of practice (Taxonomy: 363LP0808X) |
$180.00 |
96156 Modifier U1 |
Must be an acceptable complete report as described in Exhibit B, Statement of Work |
|
Clinical evaluation |
When performed by a licensed/contracted physician assistant (PA) for impairments within their licensed scope of practice (Taxonomy: 363A00000X) |
$180.00 |
96156 Modifier U2 |
Must be an acceptable complete report as described in Exhibit B, Statement of Work |
|
Missed appointment |
|
$45.00 |
99199 |
This is not paid when the Contractor is providing services at a CSO and another Client is available during that appointment time
This fee is only paid once per referral |
When testing is clinically appropriate, MIE Contractors utilize the current version of the following tests in their evaluation (whenever possible). If a Contractor does not have the current version, they notify the DSHS Contact listed on the first page of their MIE Contract to ensure the version is acceptable.
|
Service Type |
Service Description |
Reimbursement Fee |
ProviderOne Service Code |
Additional Conditions |
|---|---|---|---|---|
|
Evaluation of personality disorders |
|
$50.00
$50.00 |
96130 Modifier U6
96130 Modifier U1 |
No more than one (1) test from this category per evaluation
1May substitute the MMPI: Restructured Form provided the report documents why the substitution is necessary |
|
Evaluation of depression |
|
$10.00
$10.00 |
96130 Modifier U7
96130 Modifier U8 |
No more than one (1) test from this category per evaluation |
|
Evaluation of anxiety |
|
$10.00
$10.00 |
96130 Modifier UB
96130 Modifier UC |
No more than one (1) test from this category per evaluation |
|
Evaluation of cognitive disorders |
|
$120.00
$120.00
$30.00
$10.00 |
96130 Modifier U3
96130 Modifier U4
96130 Modifier UD
96130 Modifier U5 |
2The TONI evaluates individuals with limited language ability. It is reimbursed instead of and not in addition to the WAIS and WMS |
|
Evaluation of potential memory malingering |
|
$10.00
$30.00 |
96130 Modifier U9
96130 Modifier U2 |
No more than one (1) test from this category per evaluation |
|
Evaluation of potential psychiatric illness malingering |
|
$20.00
$10.00 |
96130 Modifier UA
96136 Modifier U1 |
No more than one (1) test from this category per evaluation |