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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 : 6.8.4 Reimbursement

6.8.4
Texas Medicaid does not reimburse pharmacological regimen oversight or pharmacological management for the actual administration of medication, or for observation of the client taking an oral medication.
Only one pharmacological regimen oversight or pharmacological management procedure code will be reimbursed for the same date of service. If the two procedure codes are billed for the same date of service by any provider, procedure code M0064 will be denied as part of procedure code 90862.
Pharmacological regimen oversight, pharmacological management, and any E/M service will be denied as part of a psychiatric diagnostic interview (procedure code 90801 or 90802) when billed for the same date of service by the same provider.
E/M services include pharmacological regimen oversight and pharmacological management. Pharmacological regimen oversight or pharmacological management will be denied as part of any E/M service billed for the same date of service, by the same provider.
If the primary reason for the office encounter or visit is for inpatient or outpatient psychotherapy or counseling, then the specific inpatient or outpatient psychotherapy or counseling procedure code must be billed. Pharmacological regimen oversight or pharmacological management will be denied as part of any outpatient psychotherapy or counseling service billed for the same date of service, by the same provider. Pharmacological management will be denied as part of any inpatient psychotherapy or counseling service billed for the same date of service, by the same provider.
Pharmacological regimen oversight or pharmacological management is limited to one service per day, per client, by any provider in any setting. Pharmacological regimen oversight is limited to the office setting.
A psychiatric diagnostic interview, pharmacological regimen oversight, pharmacological management, or any E/M service will be denied as part of narcosynthesis (procedure code 90865).
Anesthesia for ECT (procedure code 00104) will be denied as part of pharmacological management when billed on the same date of service by the same provider.
Texas Medicaid implemented mandated rate reductions for certain services. The OFL and static fee schedules include a column titled “Adjusted Fee” to display the individual fees with all mandated percentage reductions applied.
Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.
Note:
Certain rate reductions including, but not limited to, reductions by place of service, client type program, or provider specialty may not be reflected in the Adjusted Fee column.

Texas Medicaid & Healthcare Partnership
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