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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 : 6.11 Psychological and Neuropsychological Testing : 6.11.1 Prior Authorization

Psychological or neuropsychological testing requires prior authorization for services rendered in any place of service except the inpatient setting under the following circumstances:
Prior authorization must include documentation of medical necessity, and must be submitted on a Psychological/Neuropsychological Testing Request Form.
If the client requires more than four hours of testing per day, or more than eight hours of psychological or neuropsychological testing per calendar year, additional documentation is required to support the medical necessity for the additional hours. Additional testing hours may be considered as an exception on a case-by-case basis when supported by medical necessity. The number of hours prior authorized are based on the medical necessity as supported by the documentation provided. All documentation must be maintained by the provider in the client’s medical record.

Texas Medicaid & Healthcare Partnership
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