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38.3.3 Therapy
When multiple counseling codes are billed by the same provider on the same day, only the most inclusive code is paid.
If procedure code 1-90802 and 1-90801 are billed on the same day by the same provider, 1-90802 is denied as part of another procedure billed on the same day. Procedure codes 1-90801 and 1-90802 are limited to once per day per client by any provider, regardless of the number of professionals involved in the interview, and once per year per provider (same provider) in any setting.
If procedure code 1-90801 or 1-90802 is billed, the following procedure codes are denied as part of the initial psychiatric exam if billed on the same day by the same provider:
Procedure codes 1-90846 and 1-90849 are not reimbursed by the Texas Medicaid Program. Outpatient psychotherapy (procedure codes 1-90804, 1-90847, 1-90853, and 1-90857) billed on the same date of service as narcosynthesis (procedure code 1-90865) or psychoanalysis (procedure code 1-90845) is denied.
When billing or providing procedure code 1-90847, note the following requirements for Medicaid reimbursement:
• The client must be present when family therapy/counseling services are provided.
•Family therapy/counseling is only reimbursable for one family member per session.
Counseling performed by a licensed psychologist must be billed using the following procedure codes:
Psychoanalysis must be billed using procedure code 1-90845.
Counseling is denied if any of the procedure codes in the table below are billed on the same day as procedure code 1-90845.
When individual, group, or family counseling is billed by any provider on the same day, each type of session is paid. When multiples of each type of session are billed, the most inclusive is paid and the others are denied.
When billing for contracted therapy services provided to Medicaid clients who are younger than 21 years of age and reside in a residential treatment facility, use place of service (POS) 9 (other location).
According to the definition of "family" provided by HHSC Household Determination Guidelines, only specific relatives are allowed to participate in family counseling services. These guidelines also address the roles of relatives in supervision and care of Temporary Assistance for Needy Families. The following specific relatives are included in family counseling services:
•Father or mother.
•Grandfather or grandmother.
•Brother or sister.
•Uncle, aunt, nephew, or niece.
•First cousin or first cousin once removed.
•Stepfather, stepmother, stepbrother, or stepsister.
The following psychiatric services are not covered by the Texas Medicaid Program (except where specifically indicated in other sections):
•Services provided by an LCDC, psychiatric nurse, mental health worker, or psychologist assistant.
•Thermogenic therapy, recreational therapy, psychiatric daycare, and biofeedback, music or dance therapy.
•Hypnosis.
•Adult activity and individual activity (these types of services would be payable only if guidelines of group therapy are met and are termed group therapy).
Procedure codes 1-90846 and 1-90849 are not benefits of the Texas Medicaid Program for any provider.
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