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2012 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 6. Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers : 6.8 Pharmacological Regimen Oversight and Pharmacological Management Services

6.8
Pharmacological regimen oversight (procedure code M0064) and pharmacological management (procedure code 90862) services are a benefit of Texas Medicaid when provided by a physician, CNS, NP, or PA and are limited to the following diagnosis codes:
The focus of a pharmacological management encounter or visit is the use of medication to treat a client’s signs and symptoms of mental illness. When the client continues to experience signs and symptoms of mental illness necessitating discussion beyond minimal outpatient psychotherapy or counseling in a given day, the focus of the service is broader and would be outpatient psychotherapy or counseling rather than pharmacological management.
Pharmacological regimen oversight and pharmacological management services do not count towards the 12-hour per day, per provider system limitation or the 30 encounter or visit annual limitation.

Texas Medicaid & Healthcare Partnership
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