Psychosocial Rehab (PSR)

DRAFT

  • Fees also available in Portable Document Format (PDF)
Rate Code Description Unit Type Productivity
Adjustment
1st 6 mos of Waiver Downstate Fee
Productivity
Adjustment
Months 7–12 of Waiver Downstate Fee
Year 2+
Downstate Fee
Productivity
Adjustment
7/1/18–12/31/18 Upstate Fee
Productivity
Adjustment
1/1/19–6/30/19 Upstate Fee
Year 2+
Upstate Fee
Psychosocial Rehab Bachelors Level – Indv – (on–site or non–travel off–site if provider is seeing more than one individual at the same location) per 15 minutes $ 19.96 $ 17.71 $ 15.99 $ 17.80 $ 15.79 $ 14.26
Psychosocial Rehab All other allowable professions– Indv (on–site or non–travel off–site if provider is seeing more than one individual at the same location) per 15 minutes $ 17.47 $ 15.49 $ 13.99 $ 15.57 $ 13.81 $ 12.48
Psychosocial Rehab Bachelors Level – Indv – Off–site – Use this code if total off–site session is 45 minutes or less (3 or less units). If session is more than 45 minutes use rate code XX33 for all units of the visit. Cannot submit claims for xx32 and xx33for same client, same day. per 15 minutes $ 25.95 $ 23.02 $ 20.79 $ 23.14 $ 20.52 $ 18.54
Psychosocial Rehab Bachelors Level – off– site – 4–6 units Use this code to claim for entire session when session is 1 hour or more. per 15 minutes $ 21.62 $ 19.18 $ 17.33 $ 19.28 $ 17.10 $ 15.45
Psychosocial Rehab All other allowable service personnel– Off–site – Use this code if total off–site session is 45 minutes or less (3 or less units). If session is more than 45 minutes use rate code XX35) Cannot submit claims for xx35 and xx35 for same client, same day. per 15 minutes $ 22.71 $ 20.14 $ 18.19 $ 20.24 $ 17.96 $ 16.22
Psychosocial Rehab All other allowable service personnel– off–site 4–6 units. Use this code to claim for entire session when session is 1 hour or more. per 15 minutes $ 18.92 $ 16.78 $ 15.16 $ 16.87 $ 14.97 $ 13.52

*Note: In acknowledgement of the need for checks against fraud and abuse, but to ensure a client´s access to services, service utilization in excess of the annual claim limits and "soft" unit limits will be based on medical necessity and subject to post–payment review. Documentation of the medical necessity for extended durations must be kept on file in the client´s record.

**What is non–travel off–site?
Services provided off–site are paid a significantly higher rate due to the amount of practitioner time spent in travel status; therefore, Medicaid will only reimburse one off-site travel claim per day, per location. This means that if a practitioner is providing a service to more than one individual at the same location, or if multiple services requiring separate claims are being provided to one individual at an off–site location, only one off–site claim may be submitted for any services provided at that off–site location. Any subsequent claims for services provided at the same location will require that the practitioner submit a claim using the appropriate "On–site/non–travel off–site" rate code.