Family Psychoeducation

Revised: October 17, 2022

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization

· Billing

· Legal References

Overview

Family psychoeducation services are planned, structured and face-to-face interventions that involve presenting or demonstrating information. The goal of family psychoeducation is to help prevent relapse or development of comorbid disorders and to achieve optimal mental health and long-term resilience. It supports the member and family in understanding these factors:

· The member’s symptoms of mental illness

· The impact on the member’s development

· Needed components of treatment

· Skill development

Refer to the Family Psychoeducation Frequently Asked Questions for more information about this service.

Eligible Providers

Only mental health professionals or clinical trainees may provide family psychoeducation.

Eligible Members

Eligible MHCP members of family psychoeducation must have a diagnosis of emotional disturbance or mental illness as determined by a diagnostic assessment and be under age 21.

Covered Services

MHCP covers family psychoeducation services for any of the following in outpatient settings when directed toward meeting the identified treatment needs of each participating member as indicated in the member’s treatment plan:

· The member (individual)

· A member’s family (with or without the member present)

· Groups of members (peer group)

· Multiple families (family group)

If you believe the member’s absence from a family psychoeducation session is necessary, document the length of time and reason for the member to be absent. Family members or primary caregivers do not need to be eligible for MHCP to participate.

Family

The member’s family includes people the member, parent or guardian identify as being important to the member's mental health treatment. Family may include, but is not limited to the following:

· Parents or caregivers

· Siblings

· Children

· People related by blood or adoption

· People who are presently living together as a family unit

Do not consider shift staff or other facility staff members at the member’s residence as family members.

Peer Group

A peer group must be at least three, but no more than 12 members. The following criteria for groups applies:

· For groups of three to eight members, at least one mental health professional or clinical trainee must conduct the group.

· For groups of nine to 12 members, any combination of at least two mental health professionals or clinical trainees must co-conduct the group

Family Group

The following criteria applies for family groups:

· A family group must be at least two but no more than five families.

· For groups of five to 10 families, any combination of at least two mental health professionals or clinical trainees must co-conduct the group

Documentation of Covered Services

Refer to the following sections for documentation requirements.

Medical Necessity

Document the medical necessity for family psychoeducation in the diagnostic assessment. The diagnostic assessment must describe how the child meets criteria for a mental health condition. You may include this description in the initial assessment, in an addendum to the diagnostic assessment, or within the narrative portion of the individualized treatment plan (ITP) review process. Submit this information with any request for authorization.

Individualized Treatment Plan

Document in the ITP the specific interventions, describing how the mental health professionals will use family psychoeducation to treat the child’s mental illness.

Progress Notes

Progress notes must be legible and must include the following information, at a minimum:

· Type of service (member, family, peer group or family group)

· Date of service

· Session start and stop times

· Scope of service (nature of interventions)

· Number of attendees

· Role of attendees

· Attendees’ responses or reactions to the interventions

· Potential impact on eligible member

· Name(s) and title(s) of provider(s) who delivered the service

· Date documentation was made in the member’s record

For family psychoeducation performed by clinical trainees, the clinical supervisor must review and approve the member’s progress notes according to the clinical trainee’s supervision plan.

Noncovered Services

Family psychoeducation does not include the following:

· Communication between the treating mental health professional and a person under the clinical supervision of the treating mental health professional

· Written communication between providers

· Reporting, charting, and record keeping (These activities are the responsibility of the provider.)

· Mental health services not related to the member’s diagnosis or treatment for mental illness

· Communication provided while performing any of the following mental health services:

· Mental health case management

· In-reach services

· Youth ACT

· Intensive treatment services in foster care

Authorization Requirements

Family psychoeducation units or sessions are subject to the same calendar year, cumulative limits as psychotherapy. These limits are as follows for family psychoeducation:

· 26 hours of individual psychoeducation per calendar year, cumulative

· 26 sessions of family psychoeducation per calendar year, cumulative

· 52 sessions of peer group psychoeducation per calendar year, cumulative

· 10 sessions of family group psychoeducation per calendar year, cumulative

· A maximum of 4 units of family psychoeducation, per individual in one day

· A maximum of 1 session (or 4 units) of family psychoeducation, per family in one day

· A maximum of 1 session (or 4 units) of family psychoeducation, per family in a multifamily group in one day

· A maximum of 1 session (or 4 units) of family psychoeducation, per individual in a group setting in one day

Follow the authorization process for psychotherapy services for continuation of services.

Billing

Submit claims only for the member who is the primary subject of the family psychoeducation sessions, regardless of the number of other family or group members in the session.

When more than one family member receives services (such as two or three siblings, each receiving treatment within a specific timeframe), bill only for the time spent conducting family psychoeducation with each member.

When two professionals render group family psychoeducation, submit only one claim for each member. Professionals must determine which member each will bill for or one professional may claim for all members and reimburse the other professional.

When billing, use the following guidelines:

· Bill using MN–ITS 837P

· Enter the treating provider NPI number on each claim line

· Use HN modifier for services performed by a clinical trainee

Use the following table for billing services:

Family Psychoeducation Benefits for Children under aged 21
Procedure Code	Modifier	Brief Description	Unit	Service Limitation
H2027		Family Psychoeducation Individual (with a single member)	15 min	Calendar year threshold, see Authorization—104 units. Maximum 4 units/day.
	HQ	Family Psychoeducation Member Group (with multiple members)		Calendar year threshold, see Authorization—52 sessions. Maximum 1 session (6 units)/day.
	HR	Family Psychoeducation Member and Family (with a single member and their family)		Calendar year threshold, see Authorization—26 sessions. Maximum 1 session (6 units)/day.
	HS	Family Psychoeducation Family (with a single family individual not present)		Calendar year threshold, see Authorization—26 sessions. Maximum 1 session (6 units)/day.
	HQ HR	Family Psychoeducation Family Group (with multiple families with individuals present)		Calendar year threshold, see Authorization—10 sessions. Maximum 1 session (8 units)/day.
	HQ HS	Family Psychoeducation Family Group (with multiple families individuals not present)		Calendar year threshold, see Authorization—10 sessions. Maximum 1 session (8 units)/day.

Legal References

Minnesota Statutes 256B.0671, subdivision 5