Fee schedule: Community Mental Health Program Psychologist

Initial assessment and assessment form

Includes all visits required to complete initial assessment and to complete the Community Mental Health Program Assessment Form.

Initial assessment and assessment form
Service Minimum visits Service date Fee code Fees

Assess injured/ill person, complete and submit assessment form to the WSIB within 5 business days of last assessment visit

1

Date of last assessment visit

MHPIAF

$1,680

Assess injured/ill person, complete and submit assessment form to the WSIB after 5 business days of last assessment visit

1

Date of last assessment visit

MHPIAF

$1,600

Treatment

A treatment block includes 6 treatment visits delivered within up to 8 weeks.

Treatment
Service Minimum visits Service date Fee code Fees

Treatment Block (6 treatment visits delivered within up to 8 weeks)

Enter number of treatment visits provided in this block

Date of first treatment visit in this block

MHPBT

 

$1,200

 Progress form

Reassessment and completion of a Community Mental Health Program Progress form is required at the end of each treatment block or when a patient is discharged from care.

Community Mental Health Program Progress Form
Service Minimum visits Service date Fee code Fees

Progress form submitted to the WSIB
within 5 business days of last treatment visit or at end of week 8

 N/A

Date of last treatment visit in a treatment block or end of week 8

MHPBTF

$100
Progress form submitted to the WSIB after 5 business days of treatment visit N/A

Date of last treatment visit in a treatment block or end of week 8

MHPBTF

 $40

Return-to-work recommendations form

Completion of the Return-to-work recommendation form is required when the opportunity for return to work is identified. The form is used to share information with the employer to plan the person's early and safe return to work. Additional forms can be submitted when there is a change in the person’s condition that affects return-to-work activities and planning.

Return-to-work recommendation form
Service include Service date Service code Fees

Assess injured/ill person's restrictions/ limitations/accommodations, complete and submit form on same day of visit

Date of visit

MHPRTW

$45

This fee schedule may only be used by psychologists and psychological associates registered with the WSIB Community Mental Health Network

WSIB Community Mental Health Program requirements

  • The WSIB requires pre-authorization to complete and bill for the Community Mental Health Pro- gram assessment for both pending and accepted claims.
  • Treatment may only be billed for accepted claims.
  • The Community Mental Health Program Assessment form must be completed and submitted to the WSIB
  • within five business days of the date of the last assessment visit.
  • The Community Mental Health Program Progress form(s) must be completed and submitted to the WSIB within five business days from the date of the last treatment block visit (6th visit, or 8th week, whichever comes first).
  • The minimum number of visits (3) per block must be delivered to bill the full treatment block fee; otherwise, the treatment block fee will be reduced by 50 per cent.
  • The Community Mental Health Program Return-to-work recommendations form must be completed and submitted to the WSIB on the same day as the visit.

Billing instructions

General

  • Bill electronically for treatment through, TELUS Health, at the completion of each treatment block.
  • Payment for treatment will be withheld until the WSIB has received the corresponding Com- munity Mental Health Program Progress form.
  • When billing for treatment, please enter the service code on one line with the number of visits (units) in the appropriate field and the corresponding fee.
  • If HST is applicable, record it on the same bill but on a separate line using the service code “ON- HST”.
  • For further information on electronic billing, please contact TELUS Health at 1-866-240-7492 or visit www.telushealth.com/wsib.

Forms

  • Submission of the Community Mental Health Program Assessment form will generate an automatic invoice; electronic billing is not required for this form.
  • Submission of the Community Mental Health Program Progress form is required at the end of each treatment block or at the time of discharge from care. Submission of this form will generate an automatic invoice for the form fee; electronic billing is not required for this form.
  • Submission of the Community Mental Health Return-to-work recommendations form will generate an automatic invoice; electronic billing is not required for this form.
  • The Initial Assessment form and Progress form must be completed and submitted within five (5) business days of service completion. A reduction in fees will apply when forms are submitted after five business days.
  • Payment for all forms will be processed upon receipt of the forms.

You can submit the completed form(s) using our online services