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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 : 6.8.1 Indications for Pharmacological Regimen Oversight and Pharmacological Management Services

6.8.1
Pharmacological regimen oversight refers to a brief, face-to-face office encounter or visit for the sole purpose of evaluating, monitoring, or changing drug prescriptions or simple drug dosage adjustments and is a lesser level of drug monitoring than pharmacological management.
Pharmacological management refers to the in-depth management of psychopharmacological agents, which are medications with potentially significant side effects, and represents a very skilled aspect of client care. It is intended for use for clients who are being managed primarily by psychotropics, antidepressants, ECT, or other types of psychopharmacologic medications. Pharmacological management cannot be billed when only a brief office encounter or visit to evaluate the client’s state is provided. Pharmacological management can be provided in both the inpatient and outpatient settings.
Pharmacological management must be provided during a face-to-face encounter or visit with the client and any inpatient or outpatient psychotherapy or counseling provided during the pharmacological management encounter or visit must be less than 20 minutes.
Pharmacological management and pharmacological regimen oversight describes a physician service and cannot be provided by a nonphysician or “incident to” a physician service, with the exception of CNS, NP, and PA providers whose scope of license in this state permits them to prescribe.

Texas Medicaid & Healthcare Partnership
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