Florida Medicaid
Authorization Required for Psych Testing; Learning-Related Testing not Covered
The Florida Medicaid Prepaid Mental Health Plans (PMHP) offer psychological testing as a covered benefit with a maximum of 40 quarter-hour units per recipient, per state fiscal year (July 1 through June 30). However, be sure to check plan exclusions, which include learning-related testing, in your Florida Medicaid Community Behavioral Health Coverage and Limitations Handbook; a resource which you received with your Florida Medicaid number.
Psych Testing and Evaluation Process
The psychological evaluation does not require preauthorization when rendered by a network provider. But, if you plan to administer psychological testing as part of the evaluation process, a prior authorization is required. The preauthorization process for psychological testing requires a separate billing code and a Psychological Testing Request Form (PDF). You can obtain this form and instructions (PDF) from this Magellan provider website by selecting “forms” and then “clinical forms.” The psychologist requesting the testing must complete the form and fax it to 1-443-896-1549 or 1-443-896-1550.
Completing the form in its entirety helps expedite your request. You will need to list the specific psych tests being requested. Standard testing times (TIP guidelines) will be applied; additional time for interpretation and write up will be included in the authorized units of testing.
Learning-Related Psych Testing
The school system has the primary responsibility of testing children to diagnose learning disorders, obtain intelligence quotient and determine school placement. We strongly recommend that you obtain and review school records prior to submitting a testing request to Magellan. We will not authorize duplicate testing or testing that is the responsibility of the education system.
Magellan reimburses testing as it relates to diagnosis and treatment of covered mental health disorders. We will not reimburse for two or more tests that measure the same functional domain.
All testing requests received are reviewed by a Magellan-employed psychologist licensed in the State of Florida.
For further information, please review the Florida Medicaid medical necessity criteria in the Florida Medicaid Provider Handbook Supplement for your specific area.