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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 : 6.11 Psychotherapy or Counseling

6.11
Psychotherapy or counseling is the treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contract with the client and, through definitive therapeutic communication or therapeutic interactions, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.
Psychotherapy or counseling is limited to the following diagnosis codes:
The appropriate service is chosen based on the type of inpatient or outpatient psychotherapy or counseling, the place of service, the face-to-face time spent with the client during inpatient or outpatient psychotherapy or counseling, and whether E/M services are furnished on the same date of service as inpatient or outpatient psychotherapy or counseling.
The treating provider must document the medical necessity for the chosen treatment in the client’s medical record and also include the diagnosis code that most accurately describes the client’s condition that necessitated the psychotherapy or counseling. The medical record (inpatient or outpatient hospital records, reports, or progress notes) must be signed and dated by the performing provider, and should be clear and concise, documenting the reasons for the psychotherapy or counseling and the outcome.
Inpatient and outpatient psychotherapy or counseling counts towards the 12-hour per day, per provider system limitation.

Texas Medicaid & Healthcare Partnership
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