A. Clinical Psychologist (CP) Defined
To qualify as a clinical psychologist (CP), a practitioner must meet the following requirements:
Hold a doctoral degree in psychology;
Be licensed or certified, on the basis of the doctoral degree in psychology, by the State in which he or she practices, at the independent practice level of psychology to furnish diagnostic, assessment, preventive, and therapeutic services directly to individuals.
B. Qualified Clinical Psychologist Services Defined
Effective July 1, 1990, the diagnostic and therapeutic services of CPs and services and supplies furnished incident to such services are covered as the services furnished by a physician or as incident to physician’s services are covered. However, the CP must be legally authorized to perform the services under applicable licensure laws of the State in which they are furnished.
C. Types of Clinical Psychologist Services That May Be Covered
Diagnostic and therapeutic services that the CP is legally authorized to perform in accordance with State law and/or regulation. Carriers pay all qualified CPs based on the physician fee schedule for the diagnostic and therapeutic services. (Psychological tests by practitioners who do not meet the requirements for a CP may be covered under the provisions for diagnostic tests as described.
Services and supplies furnished incident to a CP’s services are covered if the requirements that apply to services incident to a physician’s services, as described in §60 are met. These services must be:
• Mental health services that are commonly furnished in CPs’ offices;
• An integral, although incidental, part of professional services performed by the CP;
• Performed under the direct personal supervision of the CP; i.e., the CP must be physically present and immediately available;
• Furnished without charge or included in the CP’s bill; and
• Performed by an employee of the CP (or an employee of the legal entity that employs the supervising CP) under the common law control test of the Act, as set forth in
20 CFR 404.1007 and §RS 2101.020 of the Retirement and Survivors Insurance part of the Social Security Program Operations Manual System.
• Diagnostic psychological testing services when furnished under the general supervision of a CP.
Carriers are required to familiarize themselves with appropriate State laws and/or regulations governing a CP’s scope of practice.