1.5 Psychological (Including Psychiatric and Neurofunctional) Services

The practitioner shall provide a written treatment plan prior to beginning psychological restoration services. The complexity of the treatment plan will vary depending on the type of services being provided, and it may include services provided by other practitioners. The plan may be a stand-alone document, or it may be articulated in the “recommendations” section of a diagnostic report. The counselor, practitioner, and individual with a disability must reach agreement concerning the goal of planned treatment and the scope, intensity, and duration of treatment services prior to implementation of mental restoration services.

DVR support for all psychological treatment will not exceed 12 sessions and six months’ duration. Purchase of treatment services beyond 12 sessions and six months requires supervisor approval after each additional six sessions and three months duration.

Rates of payment for evaluation, counseling, and psychotherapy vary depending on the practitioner providing the service, the length of the session, and whether the psychotherapy is provided individually or in a group setting.

Evaluation, counseling, and psychotherapy services will only be purchased from a community mental health center that is licensed by the Colorado Department of Public Health and Environment when an individual is not eligible for the service under the center's targeted population criteria. DVR may pay an individual's co-payment for such services when the individual's financial circumstances warrant. Treatments for services from mental health centers require an encounter between the individual and the mental health professional providing services for payment. Treatment may take place on a one-on-one basis or may be provided to a group of not more than 12 individuals. The fee for a treatment service is determined by the credential level of whom provides the service. The following rates have been determined by applying the appropriate conversion factor to the allowable CPT codes for psychological testing and psychotherapy.

Psychiatrist licensed under CRS 12-36-107

• Individual

  • Evaluations per hour (96101) $324.87

  • 30 minutes (90832) $74.97

  • 45 Minutes (90834) $95.80

  • 60 Minutes (90837) $141.61

• Group per hour (90853) 28.32

Psychologist licensed under CRS 12-43-303

• Individual

  • Evaluations Per Hour (96101) $180.68

  • 30 Minutes (90832) $67.47

  • 45 Minutes (90834) $86.22

  • 60 Minutes (90837) $127.45

• Group per hour (90853) $25.49

Professional Counselor Licensed under CRS 12-43-601

• Individual

  • Evaluations Per Hour (96101) $150.56

  • 30 Minutes (90832) $56.23

  • 45 Minutes (90834) $71.85

  • 60 Minutes (90837) $106.21

• Group per hour (90853) $21.24

Clinical Social Worker licensed under CRS 12-43-403

• Individual

  • Evaluations Per Hour (96101) $150.56

  • 30 Minutes (90832) $56.23

  • 45 Minutes (90834) $71.85

  • 60 Minutes (90837) $106.21

• Group per hour (90853) $21.24

Marriage and Family Therapist licensed under CRS 12-43-501

• Individual

  • Evaluations Per Hour (96101) $150.56

  • 30 Minutes (90832) $56.23

  • 45 Minutes (90834) $71.85

  • 60 Minutes (90837) $106.21

• Group per hour (90853) $21.24

Psychiatric Mental Health Nurses licensed under CRS 12-38-111

• Individual

  • Evaluations Per Hour (96101) $150.56

  • 30 Minutes (90832) $56.23

  • 45 Minutes (90834) $71.85

  • 60 Minutes (90837) $106.21

• Group per hour (90853) $21.24

Clinical Specialists in psychiatric mental health nursing licensed under CRS 12-38-111

• Individual

  • Evaluations Per Hour (96101) $150.56

  • 30 Minutes (90832) $56.23

  • 45 Minutes (90834) $71.85

  • 60 Minutes (90837) $ 106.21

• Group per hour (90853) $21.24

The group CPT code (90853) applies to both inpatient and outpatient group therapy. The maximum allowable fee is the rate identified above or the actual billed charge, whichever is less.

Psychiatrist licensed under CRS 12-36-107

• Evaluations per hour (90791, 96101) $324.87, $200.75

• Individual Add-ons

  • 30 minutes (90833) $49.98

  • 45 Minutes (90836) $79.99

  • 60 Minutes (90838) $129.12

• E&M CPT Codes, not add-ons

  • 99212, $60.96

  • 99213, $91.44

  • 99214, $137.16

  • 99215, $198.12

(Procedure codes 05500-01, 13500-01)

Behavior analysis is the process of studying behavior so that appropriate behavioral interventions can be put into place. A qualified behavior analyst provides assessment, consultation and/or counseling services to an individual, job coach, employer, and co-workers, etc. to identify antecedents to workplace behaviors and individualized techniques and strategies to modify behaviors.

Functional Behavioral Assessment includes administration of standardized and non- standardized tests, trauma screening, detailed behavioral history, observation of the individual, caregiver interview, job coach interview, employer interview, workplace observations, interpretation of test results, discussion of findings and recommendations to include treatment plan with the individual, primary guardian(s), caregiver(s), employers, co-workers, and preparation of a report.

Behavioral consultation and counseling includes recommendations for behavioral interventions and development of behavioral support plans that are related to the individual’s developmental history and/or disability and are necessary for the individual to acquire or maintain emotional and behavioral regulation, adaptive skills, interactions with others and improved self- management. Intervention modalities relate to an individual’s developmental experiences, identify challenging behavioral needs of the individual, and incorporate an understanding of the impact of early experiences on the development of the individual. Specific goals and procedures for the behavioral service are established. Behavioral consultation and counseling are applicable to competitive integrated employment environments.

Rates for Behavioral Assessment, Consultation, and Counseling
Behavioral Plan Assessment - $300.00 per assessment
Behavioral Consultation and Counseling - $25.29 per 15 minutes (101.16 per hour)

NOTE: Prior to authorization, verify whether the individual has funding available in the HCBS-DD and HCBS-SLS Waiver for Behavioral Assessment, Consultation, and Counseling services specific to competitive integrated employment.

A Certified Addiction Specialist (CAS) or Licensed Addiction Counselor (LAC) overseen by the Colorado Alcohol and Drug Abuse Division of the Colorado Department of Human Services may provide substance abuse services to an individual in a program licensed by the Colorado Alcohol and Drug Abuse Division for outpatient substance abuse treatment services. Therapy may take place one-on-one or in a group of not more than 12 individuals and may be paid for services within the scope of their certification at 75% of the relative value for a physician. Substance abuse treatment services may not be purchased from programs only certified to provide Level I DUI Education and Level II DUI education and treatment.

Allowable Fees for Substance Abuse Evaluation and Counseling
CAS or Licensed Addiction Counselor

• 30 minutes individual session (CPT 90832) $56.23

• 45 minutes individual session (CPT 90834) $71.85

• 60 minutes individual session (CPT 90837) $106.21

• Inpatient and outpatient group therapy (CPT 90853) $21.24 per hour