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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 : 6.11.5 Reimbursement

6.11.5
The following procedure codes may be submitted when billing for inpatient psychotherapy or counseling services: 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, and 90847.
Outpatient psychotherapy or counseling is limited to no more than four hours per client, per day.
When more than one type of session is provided on the same date of service (inpatient or outpatient individual, group, or family psychotherapy or counseling) each session type will be reimbursed individually. Services are reimbursed only for the Medicaid eligible client per session.
When multiples of each type of session is billed, the most inclusive procedure code from each type of session is paid and the others are denied.
A CNS, NP, PA, or psychiatrist may bill an E/M visit if less than 20 minutes of outpatient psychotherapy or counseling is provided.
Only the CNS, LCSW, LMFT, LPC, NP, or PA actually performing the mental health service may bill Texas Medicaid. The CNS, LCSW, LMFT, LPC, NP, or PA must not bill for services performed by people under their supervision. A psychiatrist may bill for services performed by people under their supervision. A psychologist may bill for services performed by an LPA under their direct supervision.
The services of a psychiatric nurse or behavioral health worker are not covered by the Texas Medicaid program and cannot be billed under the provider identifier of any other outpatient behavioral health provider.
Interpretation and documentation time, including time to document test results in the client’s medical record, is not reimbursed separately. Reimbursement is included in the covered procedure codes. Providers must bill the preponderance of each half hour of group counseling sessions and indicate that number of units on the claim form.
Procedure codes 90804, 90847, 90853, and 90857 will be denied as part of narcosynthesis when billed on the same date of service by the same provider.
Psychotherapy will be denied as part of narcosynthesis when billed for 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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