L.  PSYCHOLOGICAL SERVICES—TREATMENT SERVICES

L1. How is the determination made as to whether to bill psychological services versus counseling?

This is determined by who provides the services.

Counseling provided by a licensed professional counselor (LPC); licensed clinical social worker (LCSW, formerly LMSW-ACP); or licensed marriage and family therapist (LMFT) should be billed under the procedure codes for counseling.

Behavioral health services and behavioral testing services (any test not used to determine special education eligibility) provided by a licensed specialist in school psychology (LSSP); licensed psychologist; or licensed psychiatrist should be billed under the procedure codes for psychological services-treatment.

L2. Are emergency services included in the IEP under counseling and psychological services reimbursable under SHARS?

School districts may receive reimbursement for emergency counseling and psychological services as long as the IEP includes a behavior improvement plan (BIP) that documents the need for the emergency services.

L3. How are the services listed in the behavior improvement plan (BIP) billed?

The BIP is part of the IEP. Services listed in the BIP may be billed as counseling or behavioral health services when provided by a qualified provider.

L4. What can be provided under Assessment services (96101) for special education determination? What can be provided under Evaluation services for counseling or psychological services?

For assessment services, see response to J1. For evaluations, see response to K1.

Evaluation services for counseling or psychological services are billable as counseling services when delivered by LPCs, LCSWs, LMFTs or psychological services when delivered by LSSPs, licensed psychologists or licensed psychiatrists. Evaluation services for counseling or psychological services are those testing and evaluation services required to develop or modify a BIP or other plan of care for these services.

L5. I used to bill for counseling assessments under the “old” Psychological Service code, and was not able to bill SHARS for report writing. Can I bill SHARS for my same services and now bill for report writing under Psychological Services-Assessment Services code?

Counseling services evaluation is billed as counseling services (procedure code 96152-UB). Psychological services evaluation is billed as psychological services - treatment (procedure code 96152-AH). So, if the purpose of the testing is to establish a plan of care for psychological services, that evaluation must be billed as psychological services - treatment. If the purpose of the testing is to determine eligibility in the special education program, that testing must be billed as evaluation/assessment services (procedure code 96101).

 See also Billing Guidelines on the TEA website (refer to the billing guidelines section).