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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 : 6.10 Psychiatric Diagnostic Evaluations

Procedure code 90791 is a benefit when the services are performed by LPCs, LMFTs, LCSWs, APRNs, LPAs, PLPs, psychiatrists/physician, or psychologists in the office, home, skilled nursing facility, outpatient hospital, nursing home, or other (place of service 9) settings. LPC, LMFT, and LCSW providers are expected to abide by their scopes and standards of practice.
A psychiatric diagnostic evaluation without medical services (procedure code 90791) includes a history, mental status assessment, and disposition and may include communication with family members. Documentation time and time spent on medical records are considered part of the diagnostic interview service and are not reimbursed separately.

Texas Medicaid & Healthcare Partnership
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