The Role of Child and Adolescent Psychiatrists in Reviewing Medical Necessity of Care

Revised and approved by Council on September 20, 2001
To be reviewed

The role of child and adolescent psychiatrists in the review of medical necessity of care for children and adolescents is pivotal.

Only qualified psychiatrists shall be employed or utilized by any and all types of health care fiscal intermediaries, health care utilization review programs, and/or healthcare case management entities as physician reviewers of medical necessity and/or appropriateness of treatment. The physician reviewer must be a licensed physician of the same specialty, working within the same state, and familiar with the resources available in the community.

In the case of children 14 years of age and younger the appropriate individual is a physician certified as a child and adolescent psychiatrist by the American Board of Psychiatry and Neurology or who, in addition to completing training in general psychiatry is a graduate of a training program in Child and Adolescent Psychiatry accredited by the ACGME i.e. a fully qualified child and adolescent psychiatrist.