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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 3 Inpatient Hospital (Medical/Surgical Acute Care Inpatient Facility) : 3.4 Services, Benefits, Limitations, and Prior Authorization - Inpatient Psychiatric Services : 3.4.2 General Information : 3.4.2.2 Documentation Requirements

3.4.2.2
All services require documentation to support the medical necessity of the service rendered, including all hospital services. Hospital services are subject to retrospective review and recoupment if documentation does not support the service that was submitted for reimbursement.
Documentation of medical necessity for inpatient psychiatric care must specifically address the following issues:
Supporting documentation (certification of need) must be documented in the individual client’s record. This documentation must be maintained by each facility as applicable to state and federal guidelines and be readily available for review whenever requested by the HHSC or its designee.
Psychological or neuropsychological testing, when performed in an acute care hospital or in a freestanding or state psychiatric facility does not require prior authorization; however, these facilities must maintain documentation that supports medical necessity for the testing and the testing results of any psychological or neuropsychological testing services performed while the client is an inpatient.

Texas Medicaid & Healthcare Partnership
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