ADOPTION MEDICAL SUBSIDY BILLING PROCEDURES
OUTPATIENT PSYCHOTHERAPY
Payment/reimbursement for outpatient psychotherapy can be made only when:
1. The child has been certified by Adoption Medical Subsidy Program and the related services are provided on or after the effective date of certification.
2. Documentation has been provided to the Adoption Subsidy Office that the bill has been submitted to the parent’s private health insurer when the child is covered by the parent’s plan. Rejections and/or partial payment notices from these other funding sources must be attached to the bill that is mailed to this office.
3. The bill is submitted within four months of the date of service; OR
4. If the child is covered by the parent’s private health insurance, the bill must be submitted within 4 months of the parent or provider receiving documentation of partial payment or rejection of payment by the insurance company.
5. The individual actually providing counseling or psychotherapy services is licensed by the Michigan Department of Community Health as a limited or fully licensed master’s social worker, limited or fully licensed marriage and family therapist, limited or fully licensed psychologist, limited or fully licensed professional counselor; or fully licensed medical doctor or osteopathic physician.
6. If the services are provided in another state, the individual providing the service must be licensed by the state agency responsible for licensing counselors or therapists.
7. The provider is registered on MAIN, the State of Michigan’s payment system. To register on MAIN vendors may go to www.cpexpress.state.mi.us or telephone (517) 373-4111 to obtain a registration packet by mail.
Whenever possible, the family should have the service provider bill the Adoption Subsidy Program. Bills should be mailed to:
Department of Human Services
Adoption Medical Subsidy Payments Ste. 412
P.O. Box 30037
Lansing, Michigan 48909
A faxed bill cannot be accepted.
The following information must be included on the original billing statement:
1. Parent’s name, child’s legal name and date of birth.
2. Condition certified by the Medical Subsidy program for which services are being provided and the name (or Psychotherapy Service Code) of the service.
3. Dates and specific times of service, i.e. 7:00 PM to 8:00 PM.
4. Name of individual providing the service and their license or certification number and its expiration date. Provider’s Federal ID Number or Social Security number.
5. The following statement must be signed and dated by the parent on the original billing: “I have reviewed this bill for accuracy and by my signature I am verifying that therapy was provided and the times and dates of services billed are accurate.”
6. Therapist’s original signature verifying that the services billed were provided.
Adoption Subsidy Program
Outpatient Psychotherapy Rates
The Adoption Medical Subsidy program reimburses providers for outpatient psychotherapy for the child and other related services at these maximum fees. Missed appointments are not covered.
Example: the maximum fee for a full session of individual psychotherapy is $61.00. The provider charges $100. Private insurance reimburses $51.00. In this example, the Adoption Subsidy Program would pay $10.00, the difference between $61.00, the maximum fee allowed, and $51.00, the amount reimbursed by private insurance.
Type of Service Maximum Fee
Medication Review $24.00
Clinical Diagnostic Assessment-complete $81.00
Psychological Testing with written report, per hour $47.00
Individual Psychotherapy – half session, 20-30 minutes $40.00
Individual Psychotherapy – 50-60 minutes $61.00
Family psychotherapy – half session, 20 to 30 minutes $35.00
Family Psychotherapy – 50-60 minutes $56.00
Group psychotherapy, per person per full session $19.00
Collateral: face to face interpretation or explanation
of psychological or other medical information to the family $31.00
Note: We do not reimburse for charges that are over these rates. Warrants for Adoption Medical Subsidy payments will only be issued when the payment amount totals $10.00 or more. Claims or bills submitted in the amount of $9.99 or less will not be reimbursed. Two of more bills may be submitted together to reach the $10.00 threshold.
04/2006 adoptpsychotherapybillprocedures