TMPPM 2010 > Behavioral Health, Rehabilitation, and Case Management Services Handbook > Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and Licensed Professional Counselor (LPC) > Services/Benefits, Limitations, and Prior Authorization > Prior Authorization > Initial Prior Authorization Request for Encounters/Visits beyond the 30-Encounter/Visit Limit

5.2.1.1.1 Client Condition Requirements

The following documentation requirements indicating the client conditions must be submitted when requesting the prior authorization of initial outpatient services beyond the 30-encounter/visit annual limitation:

•A description of why treatment is being sought at the present time

•A mental status examination that verifies that a diagnosis is listed in the DSM-IV-TR

•A description of any existing psychosocial and/or environmental problems

•A description of the current level of social and occupational/educational functioning