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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 : 6.9 Psychiatric Diagnostic Interviews

6.9
Psychiatric diagnostic interviews (procedure code 90801 or 90802) are benefits of Texas Medicaid when provided by psychiatrists, psychologists, NPs, CNSs, and PAs when performed in the inpatient and outpatient setting.
Psychiatric diagnostic interviews are limited to the following:
Procedure codes 90801 and 90802 are limited to the following diagnosis codes:
An interactive psychiatric diagnostic interview (procedure code 90802) may be covered to the extent that it is medically necessary. Examples of medical necessity include, but are not limited to, clients whose ability to communicate is impaired by expressive or receptive language impairment from various causes, such as conductive or sensorineural hearing loss, deaf mutism, or aphasia.
A psychiatric diagnostic interview may be incorporated into an E/M service provided the required elements of the E/M service are fulfilled. An E/M procedure code may be appropriate when the level of decision making is more complex or advanced than that commonly associated with a psychiatric diagnostic interview.
Due to the nature of these encounters or visits, the general time frame for such a diagnostic interview visit is one hour. A psychiatric diagnostic interview or an interactive psychiatric diagnostic interview examination counts towards the 12-hour per day, per provider system limitation.

Texas Medicaid & Healthcare Partnership
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