Medicaid B: Outpatient Specialized Behavioral Health Therapy (TFCBT, PCIT, PSBCBT)

• Clinical Coverage Policy 8C
• AH SOW PCIT 90837 22 Z2
• AH SOW TFCBT 90837 22 Z1 90791 22 Z1
• AH SOW Medicaid PSB CBT FY22

Submission Requirements

Trauma Focused Cognitive Behavioral Therapy (TF-CBT) Child Only

• Unmanaged benefit limited to scope in provider network contract

Parent Child Interaction Therapy (PCIT)

• Unmanaged benefit limited to scope in provider network contract

Problem Sexualized Behavior Cognitive Behavioral Therapy (PSB CBT)

• Unmanaged benefit limited to scope in provider network contract

Service Definition Authorization Parameters

Trauma Focused Cognitive Behavioral Therapy (TF-CBT) Child Only

• Unmanaged benefit limited to scope in provider network contract

Parent Child Interaction Therapy (PCIT)

• Unmanaged benefit limited to scope in provider network contract

Problem Sexualized Behavior Cognitive Behavioral Therapy (PSB CBT)

• Unmanaged benefit limited to scope in provider network contract