Non-Covered Services

The following mental health services are not covered:

1. Mental health services provided by a non-psychiatrist, except psychological testing, to a member who is inpatient and has a mental illness diagnosis (these services are included in the hospital’s payment)
2. Mileage (provider travel time is not the same as mileage)
3. Transporting a member
4. Telephone calls
5. Written communication between provider and member
6. Reporting, charting, and record keeping
7. Community planning or consultation, program consultation/monitoring/evaluation, public information, training and education activities, and resource development
8. Fundraising
9. Court-ordered services for legal purposes
10. Mental health service not related to the member’s diagnosis or treatment for mental illness
11. Services dealing with external, social, or environmental factors not directly addressing the member’s physical or mental health
12. Staff training
13. Mental health case management for members receiving similar services through the Veterans Administration (VA)
14. Duplicate services (for example, mental health case management for members receiving case management services through Home and Community Based Services [HCBS])
15. Mental health services provided by a school or local education agency, unless the school or agency is a PrimeWest Health-enrolled provider and the services are medically necessary and prescribed in the child’s ITP
16. Mental health services provided by an entity whose purpose is not health service related (for example, services provided by the Division of Vocational Rehabilitation or Jobs and Training)
17. Legal services, including legal advocacy, for the member
18. Information and referral services included in the county’s community social service plan
19. Outreach services through the community support services program
20. CTSS provided to a child who has not had a DA, except the first 30 hours provided to a child who later is assessed and diagnosed with SED at the time the services were initiated
21. CTSS concurrently provided by more than one mental health professional or practitioner (two providers may not provide services during the same time, for example, 9 – 9:15 a.m.)
22. Assistance in locating respite care, special needs day care, and assistance in obtaining financial resources, except when these services are provided as part of case management
23. Member outreach
24. Recreational services, including sports activities, exercise groups, craft hours, leisure time, social hours, meal or snack times, trips to community activities, etc.
25. Conversion therapy

PW_11-19_569
Updated_03/09/2022