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New Psychological Assessment Procedure Codes for SHARS Providers Effective January 1, 2019

Last updated on 12/21/2018

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.

Effective for dates of service on or after January 1, 2019, procedure code 96101 will be replaced by procedure codes 96130 and 96131 for psychological assessments performed by School and Health Related Services (SHARS) providers.

Providers must use procedure code 96130 for the first hour of service and procedure code 96131 for each additional hour of service. The SHARS rate for both procedure codes will be $49.64.

For more information, call the TMHP Contact Center at 800-925-9126.