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42.6.8 Evaluation/Assessment and
Psychological Services
42.6.8.1 Evaluation/Assessment
Evaluations/assessments include activities related to the evaluation of the functioning of a student for the purpose of determining eligibility, the needs for specific SHARS services, and the development or revision of IEP goals and objectives. An evaluation/assessment is billable if it leads to the creation of an IEP for a student with disabilities who is eligible for Medicaid and who is under 21 years of age, whether or not the IEP includes SHARS.
Evaluations/assessments (1-96101) must be provided by a professional who is a licensed specialist in school psychology (LSSP), a licensed psychologist, or a licensed psychiatrist in accordance with 19 TAC §89.1040(b)(1) and 34 CFR §300.136(a)(1).
Evaluation/assessment billable time includes:
• Psychological, educational, or intellectual testing time spent with the student present.
•Necessary observation of the student associated with testing.
•A parent/teacher consultation with the student present that is required during the assessment because a student is unable to communicate or perform certain activities.
•Time spent without the student present for the interpretation of testing results.
Time spent gathering information without the student present or observing a student is not billable evaluation/assessment time.
Occupational therapists, physical therapists, audiologists, and SLPs who perform an evaluation should bill for their time under their individual procedure codes (1-97003, 1-97001, and 1-92506, with modifier U9, or 1-92506, with modifier GN).
Assessments for visual impairment that are performed by a licensed physician can only be billed under the medical services procedure code 1-99499. State-mandated vision and hearing screenings are not billable under SHARS.
Session notes are not required; however, documentation must include the billable start time, billable stop time, total billable minutes, and must note which assessment activity was performed (e.g., testing, interpretation, or report writing).
Evaluation/Assessment Billing Table
Providers may bill in partial hours, expressed as 1/10th of an hour (six-minute segments). For example, express 30 minutes as a billed quantity of 0.5.
Refer to: "Billing Units Based on an Hour" .
The recommended maximum billable time is eight hours over several days. Time spent for the interpretation of testing results without the student present is billable time. Providers must submit documentation of the reasons for the additional time, if more than the recommended maximum time is billed.
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