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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 : 6.9.4 Reimbursement

6.9.4
A psychiatric diagnostic interview (procedure code 90801) will be denied as part of an interactive psychiatric diagnostic interview (procedure code 90802) when billed for the same date of service by the same provider.
Psychiatric diagnostic interviews will be denied as part of another service when billed within 30 days of any consultation (procedure codes 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, and 99255) by the same provider.
Psychiatric diagnostic interviews and pharmacological management will be denied as part of another service when billed for the same date of service by the same provider as inpatient psychotherapy (procedure code 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90853, or 90857), narcosynthesis for psychiatric diagnostic and therapeutic purposes (procedure code 90865), and ECT (procedure code 90870).
Psychiatric diagnostic interviews, insight oriented behavior modifying and/or supportive psychotherapy (procedure code 90816), pharmacological management, and any E/M service will be denied as part of another service when billed for the same date of service by the same provider as individual psychotherapy 20 to 30 minutes with medical E/M services (procedure code 90817).
Psychiatric diagnostic interviews, insight oriented behavior modifying or supportive psychotherapy (procedure code 90816 or 90817), and pharmacological management will be denied as part of another service when billed for the same date of service by the same provider as individual psychotherapy 45 to 50 minutes (procedure code 90818).
Psychiatric diagnostic interviews, insight oriented behavior modifying or supportive psychotherapy (procedure code 90816, 90817, or 90818), pharmacological management, and any E/M service will be denied as part of another service when billed for the same date of service by the same provider as individual psychotherapy 45 to 50 minutes with medical E/M services (procedure code 90819).
Psychiatric diagnostic interviews, insight oriented behavior modifying or supportive psychotherapy (procedure code 90816, 90817, or 90818), and pharmacological management will be denied as part of another service when billed for the same date of service by the same provider as individual psychotherapy 75 to 80 minutes (procedure code 90821).
Psychiatric diagnostic interviews, insight oriented behavior modifying or supportive psychotherapy (procedure code 90816, 90817, 90818, or 90819), pharmacological management, and any E/M service will be denied as part of another service when billed for the same date of service by the same provider as individual psychotherapy 75 to 80 minutes with medical E/M services (procedure code 90822).
Psychiatric diagnostic interviews, interactive psychotherapy (procedure code 90823), pharmacological management, and any E/M service will be denied as part of another service when billed for the same date of service by the same provider as interactive psychotherapy 20 to 30 minutes with medical E/M (procedure code 90824).
Psychiatric diagnostic interviews, interactive psychotherapy (procedure code 90823 or 90824), and pharmacological management will be denied as part of another service when billed for the same date of service by the same provider as interactive psychotherapy 45 to 50 minutes (procedure code 90826).
Psychiatric diagnostic interviews, interactive psychotherapy (procedure code 90824 or 90826), pharmacological management, and any E/M service will be denied as part of another service when billed for the same date of service by the same provider as interactive psychotherapy 45 to 50 minutes with medical E/M (procedure code 90827).
Psychiatric diagnostic interviews, interactive psychotherapy (procedure code 90826), and pharmacological management will be denied as part of another service when billed for the same date of service by the same provider as interactive psychotherapy 75 to 80 minutes (procedure code 90828).
Psychiatric diagnostic interviews, interactive psychotherapy (procedure code 90828), pharmacological management, and any E/M service will be denied as part of another service when billed for the same date of service by the same provider as interactive psychotherapy 75 to 80 minutes with medical E/M (procedure code 90829).
Psychiatric diagnostic interviews, pharmacological regimen oversight, pharmacological management, and any E/M service will be denied as part of another service when billed for the same date of service by the same provider as narcosynthesis (procedure code 90865).
Pharmacological regimen oversight, pharmacological management, and any E/M service will be denied as part of a psychiatric diagnostic interview (procedure codes 90801 and 90802) when billed for the same date of service by the same provider.
Psychiatric diagnostic interviews, pharmacological management, and any E/M service will be denied as part of group outpatient psychotherapy or counseling (procedure code 90853 or 90857).

Texas Medicaid & Healthcare Partnership
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