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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 : 6.13 Treatment for Alzheimer’s Disease and Dementia

6.13
Alzheimer’s disease and dementia (diagnosis codes F0390, F0391, G3184, and R41841) are valid diagnoses for the following procedure codes:
 
Treatment for clients with Alzheimer’s disease or dementia is a benefit of Texas Medicaid for clients in the following stages:
The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia.
The person may feel as if he or she is having memory lapses (e.g., forgetting familiar words or the location of everyday objects) but no symptoms of dementia can be detected during a medical examination or by friends, family, or co-workers.
Friends, family, or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common stage 3 difficulties include:
Documentation to support the treatment for Alzheimer’s disease or dementia must be maintained in the client’s medical record and may be subject to retrospective review. Psychotherapy services that are no longer beneficial to the client must not be continued.

Texas Medicaid & Healthcare Partnership
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