Page 23

UNOFFICIAL 1737-23 (4) Reimbursements to the physician or psychologist shall be denied when forms are not received within the specified time. (d) Outpatient visits for psychiatric care shall be as follows: (1) Emergency room service in a licensed general hospital may be provided to patients with psychiatric problems. Services shall consist of examination for clinical impression and treatment; and Office or clinic visits shall be a face to face, personal contact between the patient and the authorized therapist for therapy or for a diagnostic purpose. (e) Outpatient visits shall not be reimbursed for time spent beyond one hour for individual therapy; or two hours for group therapy. (f) The number of visits shall be as follows: (1) The maximum number of visits for the primary mode of therapy is twenty-four one hour individual visits or twenty-four one and one- half to two hour group visits within a twelve month period; (2) For a combination of group and individual psychotherapy, the maximum for the primary modality is twenty-four visits and the maximum for the secondary modality (when twenty-four of the primary modality is approved) is six visits within a twelve month period; (3) Any combination of group and individual psychotherapy is allowed, provided the total of thirty visits and the maximum for the primary modality are not exceeded; (4) One-half hour (twenty to thirty minutes), or one quarter hour (ten to fifteen minutes), as well as one hour (forty-five to fifty minutes) individual psychotherapy visits are allowed. Any combination of visits is allowed, provided the total does not exceed twenty-four one hour visits within a twelve month period; and (5) One inpatient day can be exchanged for two outpatient hours.

(g) Approval of a second request and subsequent requests shall be based on the severity of the patient's illness. (1) Severe cases shall be allowed a maximum of twenty-four visits within a twelve month period;