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Psychiatric Residential Treatment Facilities (PRTF)

Psychiatric Residential Treatment Facilities (PRTFs) services are covered for residents ages 6 to 21 who require treatment on a continuous basis as a result of a severe mental or psychiatric illness.

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Services Covered

PRTFs are designed to serve children who need long-term, more intensive treatment, and a more highly structured environment than they can received in family and other community-based alternatives to hospitalization.

Less restrictive and more homelike than hospitals, these facilities also serve children who are transitioning from hospitals, but who are still not ready for the demands of living at home or in a foster home.

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Exclusions and Limitations in Coverage

The following shall not be covered as PRTF services:

  • Chemical dependency treatment services if the need for the services is the primary diagnosis of the recipient. However, chemical dependency treatment services shall be covered as incidental treatment if minimal chemical dependency treatment is necessary for successful treatment of the primary diagnosis
  • Outpatient services
  • Pharmacy services, which shall be covered as pharmacy services in accordance with 907 KAR 1:019
  • Durable medical equipment, which shall be covered as a durable medical equipment benefit in accordance with 907 KAR 1:479

A PRTF shall not charge a recipient or responsible party representing a recipient any difference between private and semiprivate room charges.

Services shall not be covered if appropriate alternative services are available in the community.

The following shall not qualify for a PRTF service:

  • An admission that is not medically necessary
  • An individual with a major medical problem or minor symptoms
  • An individual who might only require a psychiatric consultation rather than an admission to a psychiatric facility
  • An individual who might need only adequate living accommodations, economic aid or social support services.

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Laws, Provider Letters, Billing Informaiton and Publications
 

Code of Federal Regulations (CFR)

42 CFR Parts 441 and 483

Kentucky Revised Statutes (KRS)

KRS 216B.455

Kentucky Administrative Regulations

Provider Letters

Provider letter #A-127 - NPI Contingency Plan for UB-04 Claim Form Usage (05/11/07)

To view other provider letters, refer to the Provider Letter page.

Forms

  • Map-569 -Psychiatric Preadmission Review of Elective Admissions
  • Map-570 -Certification of Need for Inpatient Psychiatric Svcs for Individuals under Age 21

Billing Information
Provider Billing Instructions

Publications
List of Psychiatric Residential Treatment Facilities

 

If Questions?
 

Regarding policy, contact:
Division of Healthcare Facilities Management
Hospital Branch
275 East Main Street
6 C-B
Frankfort, KY 40621
Phone: (502) 564-6511
Email:
CHFS DMS Webmaster

Regarding billing, contact
(800) 807-1232

Enrolling as a provider, contact (877) 838-5085 Monday to Friday 8 a.m. - 4:30 p.m. ET or visit their website.

 

Last Updated 3/30/2012
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