Provider Alert! Updates to Behavioral Health Inpatient and Outpatient Testing Evaluations

Attention: Behavioral Health Providers and Inpatient Facilities
Effective Date: January 1, 2019

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: Effective January 1, 2019, the benefit criteria for psychological, neurobehavioral, and neuropsychological testing for inpatient behavioral health and outpatient mental health services has changed for Texas Medicaid.

Inpatient Behavioral Health

• For Inpatient Behavioral Health, psychological testing evaluations codes 96130 and 96131 or neuropsychological testing evaluations codes 96132 and 96133 may be reimbursed on the same date of service (DOS) as psychological or neuropsychological testing and administration and scoring codes 96136 and 96137.
• For Inpatient Behavioral Health, psychological testing evaluations codes 96130 and 96131 or neuropsychological testing evaluations codes 96132 and 96133 may be reimbursed on the same DOS as psychological or neuropsychological testing and administration and scoring 96136 and 96137.

Outpatient Mental Health Services

• Neurobehavioral testing procedure codes 96116 and 96121 will not be paid for the same date of service to the same provider as psychological testing or neurobehavioral procedure codes: 96130, 96131,96132,96133,96136, and 96137.

Reference: Benefit Criteria to Change for Inpatient and Outpatient Mental Health Services for Texas Medicaid

How this impacts providers: Providers should become familiar with the benefit changes for behavioral health services.

Next steps for providers: Inform their office staff of the allowable code updates.

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.