When can psychotherapy be performed as a stand-alone service?

Psychotherapy can be performed as a stand-alone service when it is not related to any other medical service, which is the basis for the correct answer. In this context, psychotherapy is specifically designed to address mental health issues directly, allowing for focused therapeutic intervention that does not overlap in treatment with other medical services provided during the same encounter.

When psychotherapy is provided as a primary treatment on its own, without the need for additional evaluation and management (E/M) services, it can stand alone in terms of coding and billing. This is particularly important for documentation and ensuring compliance with payer regulations, which often mandate clear delineation between various medical services.

In contrast, the other options do not align with the set criteria for psychotherapy as a stand-alone service. For instance, it is not solely reliant on patient insistence or referral for its validity as a standalone service, nor is it appropriate when accompanied by E/M services, unless specifically structured to count as separate entities within the healthcare interaction. Thus, the emphasis is on the necessity of defining the parameters of psychotherapy as distinct from other medical services for proper coding and billing practices.