12.4 Billing Guidelines

The provider must submit a prescription (as applicable) or physician’s recommendation for requested outpatient therapy services for the CRS program staff member to issue a service authorization. Following the evaluation, if the provider determines that it is necessary for the participant to receive therapy, the provider submits a written report and recommendations identifying the type of therapy needed, the duration and the frequency. If the CRS program staff member approves the therapy, a service authorization will be issued.

If the provider provides services without a service authorization or provides services outside of the originally proposed or approved dates, payment for the services is not guaranteed.

Invoices must be submitted at least monthly, and no later than the fifteenth of each month following the service. Data supporting the service must accompany each invoice. Outpatient therapy services are delivered per the contract or the terms and conditions set forth in the service authorization. These services are authorized by CRS counselors and are reimbursed according to the reimbursement methodology described in 1 TAC §355.9040.

Ancillary goods and services must be identified on the Individualized Program Plan and preauthorized by a CRS program staff member and are reimbursed based on fee for service in accordance with 1 TAC §355.9040. See Chapter 6: General Billing Guidelines for general billing guidelines.