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Co-Payments for Behavioral Health Services
March 15, 2005

On March 10 the Office of Medical Assistance Programs posted a PROMISe™ Remittance Advice Notice to the Department of Public Welfare web site under "What’s New," (www.dpw.state.pa.us/omap/provinf/RA022105a.asp).

Effective March 1 PROMISe™ changes were implemented to correct the application of co-payments for several behavioral health services. Behavioral health services under fee-for-service have co-payment requirements, with the exception of partial hospitalization, services to children under age 18, and services to pregnant women. Certain psychotherapy services have a $.50 co-payment for each one half hour unit of service provided for all categories of recipients; except General Assistance recipients, which require a $1.00 co-payment for each half hour of psychotherapy service provided. These services include: individual psychotherapy, group psychotherapy, family psychotherapy and collateral family psychotherapy. Procedure codes are:

  • W9801- individual psychotherapy;
  • W0981 – group psychotherapy;
  • W0983 – family psychotherapy;
  • W0984 – collateral family psychotherapy;
  • W0148 – psychotherapy, individual, family or collateral in quarter hour increments after initial half hour; and
  • W0149 – psychotherapy, individual or family in quarter hour increments after the initial half hour session.

For other behavioral health services, the sliding fee co-payment scale based upon the Medical Assistance fee for the service provided is used.

MA Fee for the Service Co-Payment
$0.01 - $1.99 $0.00
$2.00 - $10.00 $0.50
$10.01 - $25.00 $1.00
$25.01 - $50.00 $2.00
$50.01 or more $3.00

For General Assistance recipients, the sliding fee co-payment is based upon the following:

MA Fee for the Service Co-Payment
$0.01 - $1.99 $0.00
$2.00 - $10.00 $1.050
$10.01 - $25.00 $2.00
$25.01 - $50.00 $4.00
$50.01 or more $6.00

Please contact Betty Simmonds at PCPA with questions about this Alert.

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