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17.3 Benefits and Limitations
17.3.1 Outpatient Counseling
CDTF services must be determined by a qualified credentialed counselor (QCC), (as defined by DSHS licensure Standards) to be reasonable and necessary for a person who is chemically dependent. Chemical dependency is defined as "meeting at least three of the diagnostic criteria for psychoactive substance dependence" in the latest edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), Fourth Edition, Text Revision. Sufficient documentation must be maintained in the client record to support the diagnosis and justify the placement decision into the program.
The Texas Medicaid Program covers outpatient counseling services for chemically dependent children and adolescents who are 13 through 17 years of age.
Children who are 10 through 12 years of age and young adults who are 18 through 20 years of age may receive chemical dependency outpatient counseling services only when the screening process indicates that the individual's needs, experiences, and behavior are similar to those of adolescent clients. Every age exception must be clinically justified, documented, and approved in writing by a QCC. Supporting documentation, including written approval by the QCC, must be maintained by the facility in the client record.
Outpatient group counseling is limited to 135 hours per client, per calendar year (January 1 through December 31). Outpatient individual counseling is limited to 26 hours per client, per calendar year. Outpatient group and individual counseling is only payable in the outpatient setting, and place of service (POS) code 5 should be indicated on the paper claim.
CDTF outpatient counseling services do not include chemical dependency education, life skills training, assessments or prevention services. Clients in a residential CDTF are not eligible for CDTF outpatient services.
Modifier HF is required on all procedures billed by CDTF/DSHS.
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