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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 : 3.4.7 Court-Ordered Services

3.4.7
A request for prior authorization of court-ordered services must be submitted no later than seven calendar days after the date on which the services began.
Court-ordered services are not subject to the 12-hour system limitation per provider, per day when billed with modifier H9.
Court-ordered services are not subject to the five day admission limitation or the seven day extended stay limitation. Court-ordered services include:
For court-ordered admissions, a copy of the doctor’s certificate and all court-ordered commitment papers signed by the judge must be submitted with the Psychiatric Inpatient Extended Stay Request Form.
Specific court-ordered services for evaluations, psychological or neuropsychological testing, or treatment may be prior authorized as mandated by the court. A copy of the court document signed by the judge must accompany prior authorization requests. If the requested services differ from the court order, the additional services will be reviewed for medical necessity. Requested services beyond those court-ordered are subject to medical necessity review.

Texas Medicaid & Healthcare Partnership
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