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Benefit Criteria to Change for Psychotherapy and Psychiatric Diagnostic Evaluation Services

Last updated on 10/16/2020

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 November 1, 2020, benefit criteria will change for psychotherapy and psychiatric diagnostic evaluation services.

The following diagnosis codes will no longer be reimbursed for psychotherapy and psychiatric diagnostic evaluation services procedure codes 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, and 90853:

Diagnosis Codes

T50912A

T50912D

T50912S

T50914A

T50914D

T50912S

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