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December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 4 Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and Licensed Professional Counselor (LPC) : 4.2 *Services, Benefits, Limitations, and Prior Authorization : 4.2.1 Prior Authorization : 4.2.1.3 Prior Authorization for Court-Ordered and Department of Family and Protective Services (DFPS)-Directed Services

4.2.1.3
A request for prior authorization of court-ordered or DFPS-directed services must be submitted no later than seven calendar days after the date on which the services began.
Specific court-ordered outpatient behavioral health services for evaluations, psychological or neuropsychological testing, or treatment may be prior authorized as mandated by the court. Prior authorization requests must be accompanied by a copy of the court document signed by the judge. If the requested services differ from or go beyond the court order, the additional services will be reviewed for medical necessity.
Specific DFPS-directed services for outpatient behavioral health services may be prior authorized as directed. Prior authorization requests must be accompanied by a copy of the directive or summary signed by the DFPS employee. If the requested services differ from or go beyond the DFPS direction, the additional services will be reviewed for medical necessity.
Court-ordered or DFPS-directed services must be submitted with modifier H9.
Mail or fax prior authorization request to:
Texas Medicaid & Healthcare Partnership
Special Medical Prior Authorization
12357-B Riata Trace Parkway, Suite 100
Austin, TX 78727
Fax: 1-512-514-4213
Providers can submit requests for extended outpatient psychotherapy or counseling through the TMHP website at www.tmhp.com.
Refer to:
Subsection 5.5.1, “Prior Authorization Requests Through the TMHP Website” in Section 5, “Prior Authorization” (Vol. 1, General Information) for additional information, including mandatory documentation and retention requirements.

Texas Medicaid & Healthcare Partnership
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