Medical Policy                                       

Policy Num:       03.001.007
Policy Name:     HOME PSYCHIATRIC SERVICES
Policy ID:          [ 03.001.007][Ar /L M+ P+ ][0.00.00]

Last Review:      November 14, 2019
Next Review:      N/A
Issue:                  11:2019

ARCHIVED

Related Policies: None

HOME PSYCHIATRIC SERVICES

Summary

Home psychiatric services are those psychiatric, psychological or psychotherapeutic services rendered by a licensed professional to a patient restricted to his home or residence. These services are considered for payment when the patient has a psychiatric or psychological condition for which leaving his place of residence is psychologically or medically contraindicated.  These services include therapies in the home as well as emergency consultations.

Objective

The objective of this review is to provide and compare effectiveness of treatment given at home to patients because they are restricted due to mental or physical illness.

Policy Statements

Psychiatric services in the home will be covered for payment when they comply with what is expressed in the summary.

Policy Guidelines

Patients with severe mental illness often are complicated with incapacitating physical disease like cardiovascular, metabolic or neurological disease. Often these patients refuse or are unable to attend a clinic to receive treatment. Management at the home setting should be provided.

Benefit Application

BlueCard/National Account Issues

Background

Given the risks of cardiovascular and other disease in this population and their impact on mortality, the psychiatrist should consider treating metabolic abnormalities during the SMI encounter, eg, by prescribing medications to treat hyperglycemia, hyperlipidemia, and/or hypertension. The psychiatrist’s ability to do so may be influenced by his/her level of comfort, the presence of organizational support, or the availability of a primary care clinician or specialist for consultation.

This would ideally be done in consultation with primary care or subspecialty clinicians, or in an integrated medical home model. When patients are more complex, or consultation is unavailable, patient referral to family medicine, internal medicine, endocrinology, or cardiology can be more successful when facilitated by a care manager or other allied health professional. Such personnel can also facilitate collaboration among clinicians, as well as patient navigation of often complex health care systems.

Regulatory Status

N/A

Rationale

For some severely mentally ill (SMI) patients, the mental health care setting is their only site of clinical care. Some patients are unable or unwilling to follow through on a referral to primary care or attend regular visits for a chronic condition.

Population Reference No. 1 Policy Statement

For patients restricted to his home or residence which need services rendered by a mental health icensed professional. 

Supplemental Information

n/a

Practice Guidelines and Position Statements

n/a

Medicare National Coverage

n/a

References

1.    BCBSND Bulletin 300 December 2008

2.    Current Procedural Terminology (American Medical Association 2013)

Codes

Applicable Modifiers

Text

Policy History