Reimbursement for psychological evaluations and testing is limited to the terms and conditions outlined in the Community Services Division (CSD) Mental Incapacity Evaluation (MIE) contract.
For information about this contract, visit the CSD Mental Incapacity Evaluations contract procurement page.
MIE Contractors must enroll in ProviderOne to claim reimbursement for these services. Visit the Health Care Authority’s Provider Enrollment page for additional information.
For TANF or RCA related claims the contractor must contact the CSO contact for reimbursement.
For a detailed service description of the clinical psychological/psychiatric evaluation, visit the Medical Evidence Requirements and Reimbursements section of the ESA Social Services Manual.
NOTE: The maximum payment for all evaluation and report services includes the cost of providing chart notes and medical records. Providers may choose to use a DSHS 13-865 Psychological / Psychiatric Evaluation form or provide a narrative report. The DSHS 13-865 must be typed in order to be eligible for payment.
Service Type
Service Description
Reimbursement Fee
ProviderOne Service Code
Additional Conditions
When performed by a licensed/contracted psychologist
(Taxonomy: 103T00000X)
Must be an acceptable complete report as described in Exhibit B, Statement of Work
When performed by a licensed/contracted psychiatrist
(Taxonomy: 2084P0800X)
Must be an acceptable complete report as described in Exhibit B, Statement of Work
When performed by a licensed/contracted advanced registered nurse practitioner (ARNP) for impairments within their licensed scope of practice
(Taxonomy: 363LP0808X)
Must be an acceptable complete report as described in Exhibit B, Statement of Work
When performed by a licensed/contracted physician assistant (PA) for impairments within their licensed scope of practice
(Taxonomy: 363A00000X)
Must be an acceptable complete report as described in Exhibit B, Statement of Work
This is not paid when the Contractor is providing services at a CSO and another Client is available during that appointment time
This fee is only paid once per referral
When testing is clinically appropriate, MIE Contractors utilize the current version of the following tests in their evaluation (whenever possible). If a Contractor does not have the current version, they notify the DSHS Contact listed on the first page of their MIE Contract to ensure the version is acceptable.
Service Type
Service Description
Reimbursement Fee
ProviderOne Service Code
Additional Conditions
Evaluation of personality disorders