Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter A - PURCHASED HEALTH SERVICES
Division 19 - PSYCHOLOGISTS' SERVICES
Section 354.1281 - Benefits and Limitations

(a) Subject to the specifications, conditions, requirements, and limitations established by the Texas Health and Human Services Commission (HHSC) or its designee, psychological counseling and services are covered.

(b) To qualify for reimbursement the services must be provided by a:

(c) To be payable, the services must be reasonable and medically necessary as determined by HHSC.

(d) Covered services provided by an LPA or a PLP must be billed under the Texas Medicaid program provider number of the supervising psychologist or the legal entity employing the supervising psychologist.

(e) Licensed psychologists who are employed by or remunerated by a physician, hospital, facility, or other provider may not bill the Texas Medicaid program directly for psychologists' services if that billing would result in duplicate payment for the same services. If the services are covered and reimbursable by the program, payment may be made to the physician, hospital, or other provider (if approved for participation in the Texas Medicaid program) who employs or reimburses the licensed psychologist. The basis and amount of Medicaid reimbursement depends on the services actually provided, who provided the services, and the reimbursement methodology utilized by the Texas Medicaid program as appropriate for the services and provider(s) involved.