NICU PSYCHOLOGISTS’ TOOLKIT.
A guide to advocating for - and implementing - mental health services and support
in the neonatal intensive care unit (NICU).
The Role of a NICU Psychologist
A NICU psychologist can:
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Screen parents for perinatal mental health conditions
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Implement evidenced-based individual, dyadic, and couples therapeutic interventions
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Outline recommendations for care
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Ensure families are provided with resources for follow-up care
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Promote trauma-responsive and family-centered care practices throughout the unit
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Foster equity, inclusion, and cultural humility in NICU care
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Provide neurodevelopmental assessment and follow-up
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Provide specialized didactics for staff on parental mental health, infant mental health, burnout, communication skills, and stress management
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Support staff members experiencing compassion fatigue, secondary trauma, grief, or moral distress
This skill set positions NICU psychologists to collaborate with colleagues and facilitate communication across disciplines to ensure optimal care for infants and families.
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A NICU psychologist is also able to:
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Provide case conceptualizations
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Offer staff support
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​Deliver supervision and training to students and residents
Program Development and Evaluation
With increased awareness of the burden of perinatal mental health complications, the prevalence of perinatal mood and anxiety disorders (PMADs), and the risk factors associated with having an infant in the NICU, there has been a push to provide mental health support for parents during NICU care.
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This push brings opportunities for psychologists to advocate for and develop roles to provide direct care in the NICU.
For psychologists expanding services to their local NICU, completing a needs assessment is instrumental in proposing and developing a program.
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Proposals should outline:
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What a NICU Psychologist can provide for families
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The value and benefits psychologists bring to the unit
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Options for funding such a position
Finding a champion in the hospital or unit – such as a medical director, hospital administrator, or other provider – is key. This champion can support the program and help gather key partners in the system to approve the role.
“Program development in an FCC (Fetal Care Center), NICU, or NICU follow-up clinic begins with investment from the medical directors regarding the importance of mental and emotional well-being for families and infants.”
Common questions to consider during the implementation process include:
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How will the position be funded?
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What are the billing requirements or barriers?
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Who is the identified patient for charting and billing purposes?
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Will the infant be the identified patient, with the family being offered support?
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If the infant’s caregiver is the identified patient, will that person need to be registered through the hospital as an outpatient in behavioral health or through a specialty clinic?
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Will billing then be done through the identified patient’s insurance - and will it be through medical or behavioral health billing?
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What will documentation look like for the family if it is done in the infant’s chart?
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What information will be included in the chart?
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How will information be communicated to the treatment team regarding family needs?
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Will the psychologist attend team meetings, medical rounds, psychosocial rounds?
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How will the psychologist get referrals?
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Will there be a unique order set?
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Who will be the one to request orders (MD, SW, RN or other ancillary staff)?
It will also be important to understand what the allotted hours will be for the psychologist(s) and how much time will be specific for direct patient contact versus staff support or other identified needs on the unit.
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The NICU psychologist will become part of a care team that includes medical staff (e.g. MD’s, APP’s, RN’s) and other ancillary staff (e.g. social work, chaplaincy, child life, music and art therapies, OT/ST/PT, lactation consultants). It is important for a NICU psychologist to understand the various roles and how they each contribute to the care team on the unit.
Partnering with these disciplines and utilizing their support will ease the process of integrating into the team, increase referral opportunities, and provide multidisciplinary care tailored to the families’ needs.
Institutional Considerations & Organizational Readiness
Funding NICU Psychology Services
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Funding for a NICU psychologist position or team can come from a variety of sources including:​​
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billing using Health and Behavior Current Procedural Terminology (CPT) codes
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philanthropic funds
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grants
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individual departments (e.g. Neonatology, Psychology, Psychiatry, Obstetrics and Gynecology and/or Cardiology)
Responsibilities
Each institution should prioritize its needs from among the following:
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Providing family support through screening, assessment and treatment as needed for high-risk patients on the antepartum ward, for all families in the NICU and in the High Risk Infant Follow-up Clinic. The psychologist should demonstrate competency in the interpretation of screening tests and/or psychological test results. Treatment modalities for perinatal emotional distress (including, but not limited to PPD, PTSD, Generalized Anxiety Disorder) may include individual, couples, family, and group therapy.
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Collaboration with the interdisciplinary NICU team to support the care of individual families within the guidelines of confidentiality. This may involve attending medical and/or psychosocial or discharge planning rounds on a daily or weekly basis.
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Developing and implementing educational services for staff, based on their knowledge and needs. Goals would be to facilitate their understanding of parents’ psychosocial needs, recognition of perinatal mood and anxiety disorders, methods of communicating with and supporting parents, methods for fully involving parents in family-centered developmental care, and the importance of cultural sensitivity. Educational methods including teaching during rounds, seminars, workshops, and retreats.
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Develop and implement supportive services for staff, based on their needs. This may include conducting a support group, specialty rounds (Special Care Rounds, Trauma Support Rounds, etc.) for staff, and/or referral to hospital-based and/or community-based behavioral health resources or other supportive services.
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Collaborate with the Palliative Care team - if such exists - to provide support to both families and staff during and after significant medical crises or the death of a fetus or newborn, including using debrief sessions as indicated.
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Provide services aimed at forging and enhancing parent-infant bonds, including offering infant-mental health dyadic therapy and/or group educational and support sessions to parents to help them recognize their baby’s behavior and cues, and to become as involved as possible in family-integrated developmental care.
Institutional Considerations
Before hiring a psychologist for the NICU, consider these additional questions:
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Will the psychologist have clinical responsibilities in other areas of the hospital (for example, Pediatrics, Antepartum, Mother/Baby unit, or Adult Services)? How will their time be divided?
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To whom in the organization will the psychologist report (medical and/or behavioral health)?
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With whom will the psychologist need to collaborate? Pull these people into the interview and hiring process so discussions can begin early. (Psychology, Psychiatry, OB/MFM, Neonatology, Social Work)
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Will the psychologist have an academic appointment with an affiliated university, and if so, in what department?
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Will the psychologist have any teaching responsibilities (for clinical interns, students, etc.)?
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Will there be opportunities for program expansion?
Sample Job Description
This sample job description outlines the role of a NICU Psychologist, preferred qualifications, clinical responsibilities, and additional roles that mental health professionals in the NICU might fulfill.
Documentation and Billing
IMPORTANT: This section of the toolkit is an evolving project with anticipated updates to meet changing professional and billing guidelines.
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It is highly encouraged that providers consult with institution Risk and Compliance Departments for institutional specific guidelines and requirements.
Billing requirements for psychological services, including Current Procedural Terminology (CPT) codes and Health and Behavior Assessment and Intervention (HBAI) codes, can vary by state and payer. To provide accurate and up-to-date information, it’s essential to consult authoritative sources. Here are some resources that can assist you.
Medicare Coverage Database (MCD)
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The Centers for Medicare & Medicaid Services (CMS) provides the Medicare Coverage Database (MCD), which includes Local Coverage Determinations (LCDs) and articles detailing billing and coding guidelines. To find information specific to your state:
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Visit the Medicare Coverage Database
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Enter the relevant CPT or HBAI code in the search field.
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Select your state from the dropdown menu.
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Review the resulting documents for state-specific billing requirements.
CMS.gov - Centers for Medicare & Medicaid Services​
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American Psychological Association (APA)
The APA offers resources on billing and coding for psychological services:
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For psychotherapy CPT codes, visit the APA Services page on Psychotherapy Codes.
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Health Behavior Assessment and Intervention CPT Codes for Psychologists factsheet (2022)
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Psychological and Neuropsychological Testing Billing and Coding Guide (2024)
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For HBAI services, refer to the Health Behavior Assessment and Intervention Services page.
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How to report interprofessional telephone/internet/electronic health record consultations
American Medical Association (AMA)
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The AMA provides a Behavioral Health Coding Resource that outlines key CPT codes for behavioral health services. This guide can help ensure accurate coding and billing practices.
State Medicaid Programs
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Medicaid coverage and billing requirements for psychological services, including HBAI codes, differ by state. Approximately 30 state Medicaid programs reimburse psychologists for HBAI services. For detailed information, consult your state’s Medicaid program or the National Council on Aging’s HBAI Documentation Packet.
SAMHSA Billing Worksheets May not currently be available
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The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed State Billing and Financial Worksheets to assist providers in identifying available billing codes by state to support physical and mental health integration. These worksheets can be a valuable tool in understanding state-specific billing codes.
Consult with your State Psychological Board
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Consult with your State Psychological Board
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Consult with your institution’s Psychology Department and the Office of Billing and Compliance (through both Medical and Mental Health billing services)