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December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 6 Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers : 6.1 Enrollment : 6.1.3 Licensed Psychological Associate (LPA)

6.1.3
LPAs must be licensed by TSBEP. LPAs are expected to abide by their scope and standards of practice.
Services performed by an LPA are a Medicaid-covered benefit when the following conditions are met:
The supervising psychologist must be in the same office, building, or facility when the service is provided and must be immediately available to furnish assistance and direction.
The LPA performing the behavioral health service must be an employee of either the licensed psychologist or the legal entity that employs the licensed psychologist.
The TSBEP requires an LPA to work under the direct supervision of a licensed psychologist and does not allow an LPA to engage in independent practice. Therefore, an LPA will not be independently enrolled in the Medicaid program and must provide services under the delegating psychologist’s provider identifier.
LPAs may perform the same outpatient behavioral health services as licensed psychologists when the licensed psychologist delegates the services and directly supervises the LPA. These services include psychiatric diagnostic evaluations, psychological and neuropsychological testing, and psychotherapy or counseling (including individual, group, or family counseling.) A modifier must be used to identify whether the psychologist or the LPA performed the service.
Psychological services provided by a psychologist or LPA must be billed with a modifier. Any claim submitted without a modifier will be denied. Psychological services provided by an LPA must be billed under the supervising psychologist’s Medicaid identifier or the Medicaid identifier of the legal entity employing the supervising psychologist.
The following modifiers are to be used with procedure codes for licensed psychologist services:
 
Claims for services that were performed by an LPA must be submitted with modifier UC and must include the LPA’s license number. Claims that are submitted with modifier UC but without the LPA’s license number are subject to retrospective review.
Retrospective review may be performed to validate that services performed on the same client are not billed for the same time and date of service, and that modifiers billed match the provider performing the services.
Services performed by the LPA will be reduced to 70 percent of the psychologist reimbursement fee schedule rate.

Texas Medicaid & Healthcare Partnership
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