Table of Contents Previous Next Index

2012 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 6. Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers : 6.4 Outpatient Behavioral Health Services : 6.4.1 Annual Encounter or Visit Limitations

Outpatient behavioral health services without prior authorization are limited to 30 encounters or visits per client, for each calendar year. An encounter or visit is defined as any outpatient behavioral health services (i.e., examination, therapy, psychological and neuropsychological testing) by any provider, in the office, outpatient hospital, nursing home, or home settings. This limitation includes outpatient encounters or visits by all practitioners.
Each individual encounter or visit and each hour of psychological or neuropsychological testing will count toward the 30-encounter or visit limitation even when services are performed by different providers on the same date of service.
Services exceeding 30 encounters or visits per calendar year, per client must be prior authorized.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.