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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 : 6.12 Psychotherapy or Counseling : 6.12.5 Reimbursement

6.12.5
The following procedure codes may be submitted when billing for inpatient psychotherapy or counseling services: 90832, 90834, or 90837, or an E/M procedure code with add-on procedure code 90833, 90836, or 90838.
Outpatient psychotherapy or counseling is limited to no more than four hours per client, per day.
Providers must bill with modifier 59 when performing individual psychotherapy (procedure codes 90832, 90834, or 90837) and family psychotherapy (procedure code 90847) on the same day for the same client. When billing for these services, providers must append modifier 59 to the family psychotherapy procedure code on the claim to indicate that the procedure or service was distinct or independent from other services performed on the same day for the same client. Documentation that supports the provision of distinct or independent services must be maintained in the client’s medical record and made available to Texas Medicaid upon request. Services are reimbursed only for the Medicaid eligible client per session.
A CNS, NP, PA, or psychiatrist may bill an E/M visit if less than 20 minutes of outpatient psychotherapy or counseling is provided.
Only the CNS, LCSW, LMFT, LPC, NP, or PA actually performing the mental health service may bill Texas Medicaid. The CNS, LCSW, LMFT, LPC, NP, or PA must not bill for services performed by people under their supervision. A psychiatrist may bill for services performed by people under their supervision. A psychologist may bill for services performed by an LPA under their direct supervision.
The services of a psychiatric nurse or behavioral health worker are not covered by Texas Medicaid and cannot be billed under the provider identifier of any other outpatient behavioral health provider.
Interpretation and documentation time, including time to document test results in the client’s medical record, is not reimbursed separately. Reimbursement is included in the covered procedure codes. Providers must bill the preponderance of each half hour of group counseling sessions and indicate that number of units on the claim form.
Texas Medicaid implemented mandated rate reductions for certain services. The OFL and static fee schedules include a column titled “Adjusted Fee” to display the individual fees with all mandated percentage reductions applied.
Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.

Texas Medicaid & Healthcare Partnership
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