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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.6 Medical Nutrition Counseling Services (CCP) : 2.6.3 Prior Authorization and Documentation Requirements

2.6.3
Prior authorization is required for services that exceed the limitations for medical nutrition therapy (assessment, reassessment, and intervention), medical nutrition group therapy, and nutrition counseling visits.
Prior authorization is also required for consideration of other health conditions that are not addressed.
The following documentation must be submitted to the CCP Prior Authorization Unit for prior authorization:
The prescribing physician and provider must maintain documentation of medical necessity, including the completed CCP Prior Authorization Request Form, in a client’s medical record. The physician must maintain the original signed copy of the CCP Prior Authorization Request Form. The completed CCP Prior Authorization Request Form is valid for a period of up to six months from the date of the physician’s signature.

Texas Medicaid & Healthcare Partnership
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