Provider Alert! Prior authorization is no longer required for Mental Health Targeted Case Management and Mental Health Rehabilitative Services
Date: August 31, 2022
Attention: Local Mental Health Authority, Behavioral Health Providers
Effective date: August 22, 2022
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Texas Children’s Health Plan (TCHP) would like to inform network providers that beginning August 22, 2022, a prior authorization is no longer required for Mental Health Targeted Case Management (MHTCM) and Mental Health Rehabilitative Services.
How this impacts providers: This direction applies to the following services:
Mental Health Targeted Case Management and Mental Health Rehabilitative Services
For Mental Health Rehabilitation Services
| Service Category | Procedure Codes | Modifiers |
| Day Program for Acute Needs | H2012 | |
| Medication Training and Support | H0034 | HQ: group services for adults
HA/HQ: group services for child/youth |
| Crisis Intervention | H2011 | HA: child/youth |
| Skills Training and Development | H2014 | HQ: group services for adults
HA: Individual services for child/youth |
| Psychosocial Rehabilitation Services | H2017 | TD: individual services provided by RN
HQ: group services HQ/TD: group services provided by RN ET: individual crisis services |
For MHTCM Procedure Code T1017 and the appropriate modifier for MHTCM:
| Modifier | Description |
| TF | Routine Case Management |
| TG | Intensive Case Management |
| HA | Child/Adolescent program |
| HZ | Funded by criminal justice agency |
As a reminder, all out of network providers will require a prior authorization and when services requested are beyond the benefit limitations.
Next steps for providers: Providers should share this communication with their staff.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
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