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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 : 6.1.4 Provisionally Licensed Psychologist (PLP)

6.1.4
Outpatient behavioral health services that are performed by a provisionally licensed psychologist (PLP) is a benefit of Texas Medicaid when all of the following conditions are met:
The services must be performed under the direct supervision of a licensed psychologist in accordance with the Texas State Board of Examiners of Psychologists (TSBEP) guidelines.
The supervising psychologist must be in the same office, building, or facility when and where the service is provided and must be immediately available to furnish assistance and direction.
The PLP who is performing the behavioral health service must be an employee of either the licensed psychologist or the legal entity that employs the licensed psychologist.
PLPs are expected to abide by their scopes and standards of practice. A PLP may perform all of the services that are benefits of Texas Medicaid when the services are performed by a psychologist. Providers may refer to Section 6, “Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers” of this handbook for guidelines, procedure codes, and diagnosis codes for services that can be performed by a psychologist.
PLPs are not independently enrolled in Texas Medicaid; therefore, they do not have a provider identifier. Claims for services that are provided by a PLP must be submitted with modifier U9 under the provider identifier of the supervising psychologist and must include the license number of the PLP. Claims that are submitted with modifier U9 but without the PLP’s license number will be subject to retrospective review.
All providers are limited to performing a combined total of 12 hours of behavioral health services per day. The 12-hour-per-day system limitation will not apply to claims that are submitted with modifier U9 because a psychologist can delegate to multiple PLPs.
Individual PLPs who perform services under the direct supervision of a psychologist will be subject to retrospective review of claims for behavioral health services that are submitted in excess of 12 hours per day.
PLP services will be reimbursed at 70 percent of the psychologist fee.

Texas Medicaid & Healthcare Partnership
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