Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Beginning August 1, 2018, “psychiatrist” will be updated to “physician” regarding reimbursement for psychiatric diagnostic evaluations in the Texas Medicaid Provider Procedures Manual (TMPPM) and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual.
TMHP will update the TMPPM, Behavioral Health and Case Management Services Handbook, subsection 4.2.6, “Psychiatric Diagnostic Evaluation” and the CSHCN Services Program Provider Manual, subsection 29.2.5 “Procedure Codes Included in the 12-Hour System Limitations.”
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.