---
kind: "section"
citation: "42 C.F.R. § 410.44"
title: "42"
number: "410.44"
heading: "Intensive outpatient services: Conditions and exclusions."
url: "https://uscodex.org/cfr/42/410.44"
---

# §410.44. Intensive outpatient services: Conditions and exclusions.

- (a) **Intensive outpatient services are services that—**
  - (1) Are reasonable and necessary for the diagnosis or active treatment of the individual's condition;
  - (2) Are reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization;
  - (3) Are furnished in accordance with a physician certification and plan of care as specified under [§ 424.24(d)](/cfr/42/424.24.md?p=d) of this chapter; and
  - (4) **Include any of the following—**
    - (i) Individual and group therapy with physicians or psychologists or other mental health professionals (including substance use disorder professionals) to the extent authorized under State law.
    - (ii) Occupational therapy requiring the skills of a qualified occupational therapist, provided by an occupational therapist, or under appropriate supervision of a qualified occupational therapist by an occupational therapy assistant as specified in [part 484](/cfr/42/part484.md) of this chapter.
    - (iii) Services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients (including patients with substance use disorder).
    - (iv) Drugs and biologicals furnished for therapeutic purposes, subject to the limitations specified in [§ 410.29](/cfr/42/410.29.md).
    - (v) **Individualized activity therapies that are not primarily recreational or diversionary.**
    - (vi) **Family counseling, the primary purpose of which is treatment of the individual's condition.**
    - (vii) Patient training and education, to the extent the training and educational activities are closely and clearly related to the individual's care and treatment.
    - (viii) **Diagnostic services.**
- (b) **The following services are separately covered and not paid as intensive outpatient services—**
  - (1) Physician services that meet the requirements of [§ 415.102(a)](/cfr/42/415.102.md?p=a) of this chapter for payment on a fee schedule basis.
  - (2) **Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act.**
  - (3) Nurse practitioner and clinical nurse specialist services, as defined in [section 1861(s)(2)(K)(ii)](/cfr/42/1861.md?p=s-2-K-ii) of the Act.
  - (4) **Qualified psychologist services, as defined in section 1861(ii) of the Act.**
  - (5) Services furnished to SNF residents as defined in [§ 411.15(p)](/cfr/42/411.15.md?p=p) of this chapter.
- (c) **Intensive outpatient programs are intended for patients who—**
  - (1) Require a minimum of 9 hours per week of therapeutic services as evidenced in their plan of care;
  - (2) Are likely to benefit from a coordinated program of services and require more than isolated sessions of outpatient treatment;
  - (3) Do not require 24-hour care;
  - (4) Have an adequate support system while not actively engaged in the program;
  - (5) Have a mental health or substance use disorder diagnosis;
  - (6) Are not judged to be dangerous to self or others; and
  - (7) Have the cognitive and emotional ability to participate in the active treatment process and can tolerate the intensity of the intensive outpatient program.

## Notes

### Amendments

[88 FR 82177, Nov. 22, 2023]

### Authority

Authority: 42 U.S.C. 1302, 1395m, 1395hh, 1395rr, and 1395ddd.

### Source

Source: 51 FR 41339, Nov. 14, 1986, unless otherwise noted.

### Amendments

[88 FR 82177, Nov. 22, 2023]