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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 : 6.11.3 Initial Outpatient Psychotherapy or Counseling for an Individual, Group, or Family

Client Condition Requirements
The following documentation requirements must be submitted when requesting prior authorization for outpatient services beyond the 30-encounter or visit annual limitation:
Initial Assessment Requirements
There must be pertinent history that contains all of the following:
Active Treatment Plan Requirements
The treatment plan must contain the following elements:
When a medication regimen is planned by a psychiatrist, PA, NP, or CNS, it must meet the following:
Discharge Plan Requirements
Discharge planning must reflect the following:

Texas Medicaid & Healthcare Partnership
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