| January 2009 |
 | Update for Outpatient Speech-Language Pathology and Physical Medicine and Rehabilitation |
| Information posted January 9, 2009: This is an update to a banner message that appeared on the November 14, 2008, Remittance and Status (R&S) Report about outpatient speech-language pathology and physical medicine and rehabilitation and to web articles that were published on this website on November 7, 2008, titled, “Outpatient Speech-Language Pathology Benefits to Change for the CSHCN Services Program,” and “Physical Medicine and Rehabilitation Benefits to Change for the CSHCN Services Program.” Click on the title to view the details. |
| December 2008 |
| CSHCN Services Program Reimbursement Rates Change for Optometrists’ Office Visits |
| Information posted December 5, 2008: Effective for dates of service on or after September 1, 2007, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates have changed for optometrists’ office visits. Claims submitted with dates of service on or after September 1, 2007, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details. |
| Correction to “Immunization Procedure Code Rate Changes for CSHCN” |
| Information posted December 23, 2008: This is a correction to an article that was published on this website on August 22, 2008, and in the November 2008 CSHCN Services Program Provider Bulletin, No. 68, titled “Immunization Procedure Code Rate Changes for CSHCN. " Click on title to view the details. |
| November 2008 |
 | CSHCN Services Program Adopts Rates for 2007 HCPCS Codes for Ambulatory Surgical Centers |
| Information posted November 7, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has adopted rates for reimbursement to ambulatory surgical centers for some 2007 Healthcare Common Procedure Coding Systems (HCPCS) codes that were effective January 1, 2007. Click on the title to view the details. |
| Claim Details for Services Must Match Prior Authorization Letter Information |
| Information posted November 7, 2008: Providers submitting claims for services for which prior authorization has been obtained must follow certain guidelines as a condition of reimbursement. Click on the title to view the details. |
| CSHCN Reimbursement Rates to Change for Clinical Laboratory, Anesthesia Services and Dental Services |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program will implement new reimbursement rates for clinical laboratory, anesthesia services, and dental services procedure codes. Click on the title to view the details. |
| Physical Medicine and Rehabilitation Benefits to Change for the CSHCN Services Program |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, benefit criteria for physical medicine and rehabilitation will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| CSHCN Services Program to Implement New Rates for Augmentative Communication Devices |
| Information posted November 7, 2008: Effective for dates of services on or after December 30, 2008, the Children with Special Health Care Needs (CSHCN) Services Program will implement new reimbursement rates for augmentative communication device (ACD) procedure codes. Click on the title to view the details. |
| Outpatient Speech-Language Pathology Benefits to Change for the CSHCN Services Program |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, benefit criteria for outpatient speech-language pathology services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| CSHCN Services Program Adopts New Rates for Some ENT Surgical Services |
| Information posted November 21, 2008: Effective for dates of services on or after November 20, 2008, the Children with Special Health Care Needs (CSHCN) Services Program adopted new rates for some ear, nose, and throat (ENT) surgery services procedure codes. Click on the title to view the details. |
| Correction to CSHCN Services Program Reimbursement Rate Changes for Clinical Laboratory, Anesthesia |
| Information posted November 28, 2008: This is a correction to a website article posted on November 7, 2008, titled “CSHCN Reimbursement Rates to Change for Clinical Laboratory, Anesthesia Services and Dental Services.“ The effective date was incorrectly stated as January 1, 2009. The correct effective date is January 1, 2007. Click on the title to view the complete, corrected article. |
| Update to CSHCN Services Program Adoption of 2007 HCPCS Codes for Ambulatory Surgical Centers |
| Information posted November 28, 2008: The Children with Special Health Care Needs (CSHCN) Services Program adopts HCPCS codes for ambulatory surgical centers. Click on the title to view the details. |
| October 2008 |
| CSHCN Services Program DME Authorization/Prior Authorization Request Form Revised |
| Information posted October 3, 2008: The “CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)” form published on this website on September 18, 2008, has been revised. The revised form contains general instructions for completing and submitting the form to TMHP. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. Click on the title to view the revised form. |
| Reminder for Cleft/Craniofacial Providers |
| Information posted October 3, 2008: As indicated in the 2008 CSHCN Services Program Provider Manual, providers of cleft/craniofacial (C/C) services must be enrolled by the Children with Special Health Care Needs (CSHCN) Services Program. Providers must also be part of a designated C/C team to receive reimbursement for surgical services from the CSHCN Services Program. Click on the title to view the details. |
| CSHCN Services Program Waiting List Information |
| Information posted October 1, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has removed 63 clients from the program's waiting list. The effective date of this removal is October 1, 2008. These new clients received a gray CSHCN Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health-care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| Reimbursement Rates to Change for Physician-Administered Drugs and Biologicals for the CSHCN Service |
| Information posted October 17, 2008: Effective for dates of service on or after November 1, 2008, reimbursement rates for procedure codes for physician-administered drugs and biologicals will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the new reimbursement rates. |
| November 2008 CSHCN Services Program Provider Bulletin No. 68 |
| Information posted October 8, 2008: The November 2008 CSHCN Services Program Provider Bulletin No. 68 is now available. Click on the title to view the bulletin. |
| CSHCN Services Program DME Authorization/Prior Authorization Request Form Revised |
| Information posted October 3, 2008: The “CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)” form published on this website on September 18, 2008, has been revised. The revised form contains general instructions for completing and submitting the form to TMHP. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. Click on the title to view the revised form. |
| Revised Synagis Prior Authorization Forms |
| Information posted October 15, 2008: This is a correction to the Texas Medicaid Palivizumab (Synagis) Prior Authorization Request Form and the CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis) located on this website. Click on the title to view the details. |
| Online Provider Enrollment |
| Information posted October 24, 2008: Reminder: Potential and current Texas Medicaid, Children with Special Health Care Needs (CSHCN) Services Program, and Primary Care Case Management (PCCM) providers can complete the initial enrollment and reenrollment applications online at the Access Provider Enrollment page on this website. Click on the title to view the details. |
| Clinician-Directed Care Coordination Services to Change for the CSHCN Services Program |
| Information posted October 24, 2008: Effective for dates of service on or after January 1, 2009, benefits for clinician-directed care coordination services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| TMHP Scheduled System Maintenance |
| Information posted October 31, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on November 9, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| CSHCN Services Program Waiting List Information |
| Information posted October 1, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has removed 63 clients from the program's waiting list. The effective date of this removal is October 1, 2008. These new clients received a gray CSHCN Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health-care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| September 2008 |
| TMHP Scheduled System Maintenance |
| Information posted September 8, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on September 14, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| CSHCN Reimbursement Rates to Change for Physician-Administered Drugs and DMEPOS |
| Information posted September 12, 2008: Effective November 1, 2008, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates will change for physician-administered drugs and durable medical equipment, prosthetic, orthotics, and supplies (DMEPOS).Click on title to view details. |
| Physical, Occupational, and Speech Therapy Benefits Changes Postponed for the CSHCN Services Program |
| Information posted September 25, 2008: This is an update to banner message that first appeared on the September 26, 2008, Remittance and Status (R&S) Report. The article stated that benefit criteria for the following services will be changing for the Children with Special Health Care Needs (CSHCN) Services Program: outpatient speech-language pathology; and physical medicine and rehabilitation. Benefit criteria will not be changing at this time for these services. The benefit changes will be effective at a later date. Providers should monitor future banner messages and bulletins for additional information about upcoming benefit changes for these services. |
| Update to "Benefit Update for Reconstructive and Cosmetic Procedures for the CSHCN Services Program" |
| Information posted September 18, 2008: This is an update to an article that was published on this website on August 8, 2008, titled "Benefit Update for Reconstructive and Cosmetic Procedures for the CSHCN Services Program." The article stated that breast reconstruction following a medically necessary mastectomy will be diagnosis-restricted. The same diagnosis restrictions will also apply to mastectomies.
Effective October 1, 2008, mastectomy procedure codes 2/F-19301, 2/F-19302, 2/F 19303, 2/F-19304, 2/F-19305, 2/F-19306, and 2/F-19307 will be restricted to the following diagnosis codes: 1740, 1741, 1742, 1743, 1744, 1745, 1746, 1748, 1749, 1750, 1759, 19881, 2330, and V103.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1 800-568-2413.
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| CSHCN Services Program Claim Filing Deadline Waived for Services to Ike Evacuees |
| Information posted September 24, 2008: In response to Hurricane Ike, the Department of State Health Services (DSHS) has directed the Texas Medicaid & Healthcare Partnership (TMHP) to waive the filing deadline for services rendered to Children with Special Health Care Needs (CSHCN) Services Program clients who are Hurricane Ike evacuees. The waiver applies to claims received with dates of service on or after September 9, 2008, and until further notice. Claims submitted after the filing deadline will initially be denied but will then be reprocessed by TMHP with no further action required by the provider. The filing deadline will be waived only for providers whose ZIP codes have been identified as an evacuation area. For more information, call the TMHP Contact Center at 1-800-568-2413. Click on the title to view the list of ZIP codes in the evacuation area. |
| 2009 ICD-9-CM Updates Now Available |
| Information posted September 26, 2008: On October 1, 2008, Texas Medicaid & Healthcare Partnership (TMHP) will apply the 2009 additions, deletions, and changes to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) effective for dates of service on or after October 1, 2008. Click on the title to view the details. |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List Information |
| Information posted September 4, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has removed 120 clients from the program's waiting list. The effective date of this removal is September 1, 2008. These new clients received a gray CSHCN Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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| Revised CSHCN Services Program DME Prior Authorization Request Form |
| Information posted September 8, 2008: The Children with Special Health Care Needs (CSHCN) Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME) form has been revised. The physician signature is required only on page 1 of the section titled “Statement of Medical Necessity”. Providers must submit page 1 of the form to TMHP, pages 2 through 5 are required only for certain DME requests. Providers can refer to the text under the form title to determine which additional pages must be submitted.
Click on the title for more details and to access the revised form. |
| Benefit Criteria for Radiology Magnetic Resonance Imaging (MRI) to Change for the CSHCN Services Pro |
| Information posted September 8, 2008: Effective for dates of service on or after November 1, 2008, benefit criteria for radiology magnetic resonance imaging (MRI) will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Benefit Criteria for Bone Growth Stimulators to Change for the CSHCN Services Program |
| Information posted September 8, 2008: Effective for dates of service on or after November 1, 2008, benefit criteria for bone growth stimulators will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| August 2008 |
| Rates to Change for Clinical Laboratory Procedure Codes |
| Information posted August 4, 2008: Effective October 1, 2008, new reimbursement rates for clinical laboratory procedure codes were adopted for the CSHCN Services Program. Click on the title to view the details. |
| Claims Engine and Long Term Care Systems Maintenance Scheduled For August, 2008 |
| Information posted August 1, 2008: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems on August 10, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details.
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| Correction to “Eye Surgery Codes Rates to Change for the CSHCN Services Program” Article |
| Information posted August 15, 2008: This is a correction to an article published on July 14, 2008, on this website, titled ”Eye Surgery Codes Rates to Change for the CSHCN Services Program.” The article incorrectly listed procedure code 2-66160 with an effective date of September 1, 2007. The correct effective date for procedure code 2-66160 is July 23, 2008. Click on title to view the revised table of eye surgery code rates. |
| Radiation Therapy Services Benefits to Change for the CSHCN Services Program |
| Information posted August 8, 2008: Effective October 1, 2008, benefits for radiation therapy services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Update to “Benefits for Dental Therapeutic Services to Change for the CSHCN Services Program” |
| Information posted August 8, 2008: This is an update and clarification to information posted on this website on July 14, 2008, titled, “Benefits for Dental Therapeutic Services to Change for the CSHCN Services Program.” The limitation for procedure code D9970 has changed, and limitations for procedure codes D9220 and D9248 have been clarified. Click on the title to view the details. |
| Benefit Update for Reconstructive and Cosmetic Procedures for the CSHCN Services Program |
| Information posted August 8, 2008: Effective for dates of service on or after October 1, 2008, benefit criteria for reconstructive and cosmetic procedures will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Reprocessing CSHCN Claims for Nutritional Product Supplements |
| Information posted August 8, 2008: TMHP has identified an issue impacting claims for medical nutritional products submitted with procedure codes B4100, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, and B4162 for dates of service from June 8, 2006 through June 10, 2008. These claims may have been denied in error.
Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.
For more information, call the TMHP-CSHCN Services Program Contact Center at
1-800-568-2413.
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| Using the CSHCN Services Program Provider Complaint Process |
| Information posted August 22, 2008: CSHCN Services Program providers can submit their complaints to the TMHP Complaints Unit. Click on title to view details. |
| Laboratory Services Benefits to Change for the CSHCN Services Program |
| Information posted August 8, 2008: Effective for dates of service on or after October 1, 2008, the benefit criteria for laboratory services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details |
| Update to Article "Preventive Care Medical Checkup Benefits to Change for the CSHCN Services Program |
| Information posted August 29, 2008: This is an update to an article published July 14, 2008 on this website titled "Preventive Care Medical Checkup Benefits to Change for the CSHCN Services Program." The article stated that the provider must refer clients for dental checkups and that the physician must complete the intermediate oral evaluation. The article has been updated to include an advanced practice nurse (APN) as an appropriate provider type for performing these services. Click on the title to view the complete, updated article. |
| Immunization Procedure Code Rates Changes for CSHCN |
| Information posted August 22, 2008: Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates were adopted following a public hearing on July 29, 2008. Click on the title to view the details.
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| July 2008 |
| Update for Anesthesia Services, Dental Therapeutic Services, and Preventative Care Medical Checkup |
| Information posted July 28, 2008: This is an update to banner messages that appeared on the July 18, 2008 Remittance and Status (R&S) Report and to web articles that were published on this website on July 14, 2008, entitled, "Benefits for Anesthesia Services to Change for the CSHCN Services Program,” "Benefits for Dental Therapeutic Services to Change for the CSHCN Services Program,” and “Preventative Care Medical Checkup Benefits to Change for the CSHCN Services Program”. Click on the title to view the details. |
| Critical Care Services Benefits to Change for the CSHCN Services Program |
| Information posted July 14, 2008: Effective for dates of service on or after September 1, 2008, the benefit criteria for critical care services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Eye Surgery Codes Rates to Change for the CSHCN Services Program |
| Information posted July 14, 2008: Effective for dates of service on or after July 23, 2008, the rates for eye surgery procedure codes will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Benefits for Anesthesia Services to Change for the CSHCN Services Program |
| Information posted July 13, 2008: Effective for dates of service on or after September 1, 2008, the benefit criteria for anesthesia will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
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| TMHP Scheduled System Maintenance - July 13, 2008 |
| Information posted July 9, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) will perform scheduled system maintenance to the claims engine and long-term care (LTC) systems on July 13, 2008, from 6:00 p.m. until 11:59 p.m., Central Time. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Benefits for Anesthesia Services to Change for the CSHCN Services Program |
| Information posted July 14, 2008: Effective for dates of service on or after September 1, 2008, the benefit criteria for anesthesia will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Preventive Care Medical Checkup Benefits to Change for the CSHCN Services Program |
| Information posted July 14, 2008: Effective for dates of service on or after September 1, 2008, the benefit criteria for preventive care medical checkups will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Benefits for Dental Therapeutic Services to Change for the CSHCN Services Program |
| Information posted July 14, 2008: Effective for dates of service on or after September 1, 2008, the benefit criteria for dental therapeutic services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| June 2008 |
| New Benefits for Bone Anchored Hearing Aid (BAHA) Devices for the CSHCN Services Program |
| Information posted June 6, 2008: Effective for dates of service on or after August 1, 2008, the bone anchored hearing aid (BAHA) device will be a benefit of the Children with Special Health Care Needs (CSHCN) Services Program for clients who are 5 years of age or older and who meet medical necessity criteria. Click on the title to view the details. |
| Vaccine/toxoid Reimbursement Changes |
| Information posted June 20, 2008: Effective for dates of service on or after August 1, 2008, the benefit criteria for vaccine/toxoids will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Provider Check Amounts Available Online |
| Information posted June 27, 2008: Beginning June 27, 2008, acute care providers can search, view, and print on this website all payment amounts issued during the previous year. Click on the title to view the details. |
| Correction to “Update to ‘New Electrodiagnostic Testing Benefits for the CSHCN Services Program’” |
| Inforamtion posted June 14, 2008: This is a correction to an article published on this website on March 24, 2008, entitled, “Update to ‘New Electrodiagnostic Testing Benefits for the CSHCN Services Program’.” The article incorrectly indicated that the total laboratory component (type of service 5) for procedure codes 51784 and 51785 will be benefits of Texas Medicaid, Also, diagnosis codes 3350, 3359, 35924, and 73605 were not included in the table of payable diagnosis codes, and diagnosis code 7605 was incorrectly added to the diagnosis table. The article also omitted some limitations for procedure codes 51784 and 51785. Click on the title to view the correct information. |
| Seating Still Available for the 2008 Success With the CSHCN Services Program Workshop |
| Information posted June 24, 2008: TMHP is presenting the Success with CSHCN Services Program workshop throughout the state, and there are seats still available. This free workshop reinforces providers’ understanding of the claims filing process for the CSHCN Services Program by focusing on the problems Program providers most often encounter when filing claims. Click on the title to view the details. |
| May 2008 |
| Providers Must Also Attest for the CSHCN Services Program |
| Information posted May 9, 2008: Effective May 23, 2008, National Provider Identifier (NPI) full compliance will be implemented. Claims submitted without an NPI will not be processed and will be denied. Providers that have completed the NPI attestation for Texas Medicaid must also complete the NPI attestation for the Children with Special Health Care Needs (CSHCN) Services Program. Providers that have not completed their NPI attestation will experience claim denials and rejections. Provider attestation can be completed on this website under the “I would like to” section on the right-hand side. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| Neurostimulator Benefits Are Changing |
| Information posted May 2, 2008: Effective for dates of service on or after June 1, 2008, the benefit criteria for neurostimulators will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| CSHCN Services Program Reimbursement Rates Assigned for Some 2008 HCPCS Procedure Codes |
| Information posted May 16, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has adopted the Texas Medicaid reimbursement rates for some 2008 annual Healthcare Common Procedure Coding System (HCPCS) procedure codes. The Texas Medicaid rates were adopted after a rate hearing held on March 18, 2008, and are effective June 1, 2008, for the CSHCN Services Program for dates of service on or after January 1, 2008. Claims submitted with any of the affected procedure codes will be reprocessed, and payments will be adjusted accordingly. No further action on the part of the provider is necessary. Click on the title to view the details. |
| Correction to “Cochlear Implants Benefits Changes for the CSHCN Services Program” |
| Information posted May 30, 2008: This is a correction to an article posted to the TMHP web site titled, “Cochlear Implants Benefits Changes for the CSHCN Services Program.” The article incorrectly stated that effective for dates of service on or after May 1, 2008, ambulatory surgical centers (free-standing and hospital-based) were no longer required to submit procedure code J-L8614 with the NU modifier. Providers were to submit procedure code 9-L8614 without a modifier for consideration of reimbursement. Click on the title to view the complete, corrected article. |
| Benefits for Anesthesia Services for the CSHCN Services Program to Change |
| Information posted May 9, 2008: Effective for dates of service on or after July 1, 2008, benefit criteria for anesthesia will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Benefits Changes for Anesthesia Services for Texas Medicaid and the CSHCN Services Program |
| Information posted May 23, 2008: Effective for dates of service on or after September 1, 2008, the benefit criteria for anesthesia will change for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Please disregard the previously published banner message and web article information for the new benefit changes. The new benefit changes for these services will be published in a future provider notification. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413. |
| TMHP Scheduled System Maintenance |
| Information posted May 30, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on June 8, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| April 2008 |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List Information |
| Information posted April 11, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has removed 226 clients from the program's waiting list. The effective date of this removal is April 1, 2008.
These new clients received a gray CSHCN Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. The program will waive prior authorization requirements for program-covered services provided to these clients between April 1, 2008, and April 18, 2008. Note that this waiver only applies to the 226 clients who are included in this release.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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| Revised CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis) Form |
| Information posted April 7, 2008: Effective June 1, 2008, the CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis) form found on page B-18 of the 2008 CSHCN Services Program Provider Manual has been revised. The revised form will be available on June 1, 2008 in the provider forms section of this website and will also be published in the August 2008 CSHCN Services Program Provider Bulletin, No. 67.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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| Eyewear Claims Reprocessing for the CSHCN Services Program |
| Information posted April 7, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue affecting claims submitted with eyewear procedure codes and modifier RP. The CSHCN Services Program allows frames to be reimbursed once per year and allows lenses to be reimbursed twice per year. Repairs or replacements of frames and lenses are allowed as needed when billed with the RP modifier. Claims submitted on or after July 6, 2007, with frames or lenses procedure codes and modifier RP may have been denied in error. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the complete list of affected procedure codes.
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| Texas Medicaid National Provider Identifier (NPI) Special Bulletin No. 217 |
| Information Posted April 23, 2008: The May 2008 Special Bulletin No. 217 is now available. Click the title to view the bulletin.
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| Nutritional Products Valine or Isoleucine |
| Information posted April 11, 2008: Effective for dates of service on or after May 1, 2008, the medical nutritional products valine (any strength) and isoleucine (any strength) will be benefits of the Children with Special Health Care Needs (CSHCN) Services Program and will be added to the CSHCN Services Program Medical Nutritional Products Formulary. Providers must use procedure code 1-A9150 to submit claims for valine or isoleucine and must enter the product name valine or isoleucine in the Remarks area of the claim. For more information, call the TMHP-CSHCN Contact Center at 1-800-568-2413.
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| Claims Engine and Long Term Care Systems Maintenance Scheduled For April 13, 2008. |
| Information posted April 4, 2008: TMHP will perform scheduled maintenance to the claims engine and long term care (LTC) systems on April 13, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| May 2008 CSHCN Provider Bulletin No. 66 |
| Information posted April 4, 2008: The May 2008 CSHCN Provider Bulletin No. 66 is now available. Click the title to view the bulletin.
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| Reconstructive Finger Surgery |
| Information posted April 25, 2008: Effective for dates of service on or after May 1, 2008, procedure code F-26587 is a benefit when performed at ambulatory surgical centers (ASC) and hospital ambulatory surgical centers (HASC). Procedure code F-26587 is reimbursed under ASC Group 5.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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| March 2008 |
| TMHP Scheduled System Maintenance |
| Information posted March 3, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on March 9, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Cochlear Implants Benefits Changes for the CSHCN Services Program |
| Information posted March 10, 2008: Effective for dates of service on or after May 1, 2008, the benefit criteria for cochlear implant services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| CSHCN Durable Medical Equipment (DME) Rate Changes |
| Information posted March 3, 2008: Effective February 27, 2008, for dates of service on or after December 1, 2006, the rates changed for some DME procedure codes. Effective February 27, 2008, for dates of service on or after October 1, 2006, the rates changed for procedure codes J/L-K0010 and J/L-K0011. Click on the title to view the details. |
| February 2008 |
| Kidney Transplant Benefit Changes for the CSHCN Services Program |
| Information posted February 4, 2008: Effective for dates of service on or after April 1, 2008, benefit criteria for kidney transplants will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List Information |
| Information posted February 28, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has removed 137 clients from the program's waiting list. The effective date of this removal is March 1, 2008. These new clients received a gray CSHCN Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. Click on the title to view the details. |
| Claims Engine and Long Term Care Systems Maintenance Scheduled For February 10, 2008 |
| Information posted February 4, 2008: TMHP will perform scheduled maintenance to the claims engine and long term care (LTC) systems on February 10, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Online Provider Enrollment Coming Soon |
| Information posted February 18, 2008: Providers will soon be able to enroll in the Texas Medicaid Program and Children with Special Health Care Needs (CSHCN) Services Program and apply for Primary Care Case Management (PCCM) credentialing on this website. Providers will have the following options: initial enrollment, reenrollment, credentialing, recredentialing, and provider information maintenance. The effective date will be published in a future banner message. Click on the title to view the details. |
| Medical Nutritional Counseling Services Benefit Changes for the CSHCN Services Program |
| Information posted February 4, 2008: Effective for dates of service on or after April 1, 2008, benefit criteria for medical nutritional counseling services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| CSHCN Attestation |
| Information posted February 18, 2008: TMHP has completed the National Provider Identifier (NPI) attestation for CSHCN Services Program providers who have completed the NPI attestation of their Texas Medicaid Program Texas Provider Identifier (TPI.) The NPI attestation was completed using the CSHCN Services Program TPI and the NPI, taxonomy code, and physical address provided during the NPI attestation with the Texas Medicaid Program.
Click on the title to view the details. |
| New Electrodiagnostic Testing Benefits for the CSHCN Services Program |
| Information posted February 11, 2008: Effective for dates of service on or after April 1, 2008, electrodiagnostic testing (electromyography [EMG] and nerve conduction studies [NCS]) services are benefits of the Children with Special Health Care Needs (CSHCN) Services Program. EMG and NCS services are limited to four occurrences/visits per calendar year when submitted for reimbursement by the same provider. Prior authorization will not be considered beyond the four occurrences. Additional nerve conduction studies per occurrence may be considered for prior authorization with documentation of medical necessity. EMG and NCS procedure codes are diagnosis restricted. Click on the title to view the details. |
| Chemotherapy Benefit Changes for the CSHCN Services Program |
| Information posted February 11, 2008: Effective for dates of service on or after April 1, 2008, benefit criteria for chemotherapy services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| First Dental Home Initiative |
| Information posted February 18, 2008: First Dental Home is a new initiative designed to help Texas Health Steps (THSteps) and Children with Special Health Care Needs (CSHCN) Services Program clients 6 months through 35 months of age to establish a dental home. Earlier oral evaluation allows earlier identification of dental needs and the start of needed preventive and therapeutic dental services. Click on the title to view the details. |
| January 2008 |
| Revised CSHCN Prior Authorization Request for Diapers, Pull-ups, Underpads, Briefs, or Liners Form |
| Information posted January 28, 2008: Effective for dates of service on or after February 1, 2008, the CSHCN Services Program Prior Authorization Request for Diapers, Pull-ups, Underpads, Briefs, or Liners Form has been revised. The revised form is available in the Provider Forms section of this website and will also be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 66. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. Click on the title to view the revised form. |
| Claims Engine and Long Term Care Systems Maintenance Scheduled For January 13, 2008. |
| Information posted January 9, 2008: TMHP will perform scheduled maintenance to the claims engine and long term care (LTC) systems on January 13, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| CSHCN Services Program Clients Removed From Waiting List |
| Information posted January 22, 2008:The Children with Special Health Care Needs (CSHCN) Services Program has removed 38 clients from the program’s waiting list. The effective date of this removal is January 1, 2008. Click on the title for details. |
| Corrected CSHCN Services Program Authorization Request for Apnea Monitor Rental Form Now Available |
| Information posted January 28, 2008: This is a correction to an article posted on this website on December 24, 2007, entitled “Respiratory Equipment and Supplies Benefit Changes for the CSHCN Services Program.” The CSHCN Services Program Authorization Request for Apnea Monitor Rental form attached to the website article has been update with the correct information for procedure code L-E0618. The corrected form is now available on this website and will be published in the May 2008 CSHCN Services Program Provider Bulletin, No.66. The form is effective for dates of service on or after April 1, 2008, and will replace the form in the 2008 CSHCN Services Program Provider Manual. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. Click on the title to view the form. |
| February 2008 CSHCN Provider Bulletin No. 65 |
| Information posted January 3, 2008: The February 2008 CSHCN Provider Bulletin No. 65 is now available. Click the title to view the bulletin. |
| December 2007 |
| H. Pylori Benefit Changes for the CSHCN Services Program |
| Information posted December 10, 2007: Effective for dates of service on or after February 1, 2008, the benefit criteria for Helicobacter pylori (H. pylori) testing will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| February 2008 CSHCN Provider Bulletin No. 65 |
| Information posted December 31, 2007: The February 2008 CSHCN Provider Bulletin No. 65 is now available. Click the title to view the bulletin.
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| Neurostimulator Benefits To Change for the CSHCN Services Program |
| Information posted December 17, 2007: Effective for dates of service on or after January 1, 2008, the benefit criteria for neurostimulators will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Revised Provider Enrollment Application Packets and Addendums |
| Information posted December 17, 2007: The Texas Medicaid Program and CSHCN Services Program Provider Enrollment Application packets and Addendums B and C for Primary Care Case Management (PCCM) providers have been revised. Click on the title to view the details. |
| Additional Oral Maxillofacial Procedure Codes To Be CSHCN Services Program Benefits |
| Information posted December 10, 2007: Effective for dates of service on or after February 1, 2008, additional procedure codes will become benefits of the Children with Special Health Care Needs (CSHCN) Services Program when submitted by enrolled oral maxillofacial surgeons. Click on the title to view the details. |
| Benefit Criteria for Expendable Medical Supplies To Change |
| Information posted December 10, 2007: Effective for dates of service on or after February 1, 2008, the benefit criteria for expendable medical supplies will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
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| November 2007 |
| Full Compliance with National Provider Identifier (NPI) To Be Required Effective March 1, 2008 |
| Information posted November 5, 2007: Effective March 1, 2008, full compliance with National Provider Identifier (NPI) will be required. Click on the title to view the details. |
| Immune Globulins Benefit Changes for the CSHCN Services Program |
| Information posted November 12, 2007: Effective November 1, 2007, for dates of service on or after July 1, 2007, providers may submit claims for immune globulin services with procedure code 1-J1567, 1-Q4087, 1-Q4088, 1-Q4090, 1-Q4091, or 1-Q4092 and an appropriate diagnosis code. Click on the title to view the details. |
| CSHCN Services Program Adds New Clients |
| Information posted November 2, 2007: The Children with Special Health Care Needs (CSHCN) Services Program has removed 57 clients from the program's waiting list. The effective date of this removal is November 1, 2007. Click on the title to view the details. |
| Correction to “2007 HCPCS Rates” Article for Procedure Code 1-S0180 |
| Information posted November 12, 2007: This is a correction to information published in the January 2007 HCPCS Special Bulletin, No. 200. The bulletin incorrectly indicated that procedure code 1-S0180 is a benefit of the Children with Special Health Care Needs (CSHCN) Services Program. Effective for dates of service on or after January 1, 2007, procedure code 1-S0180 is not a benefit of the CSHCN Services Program. In addition, an article entitled, “2007 HCPCS Rates” was published on this website on October 1, 2007, which included procedure code 1-S0180. The article should have indicated that procedure code 1-S0180 is not a benefit of the CSHCN Services Program. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| October 2007 |
| Revised CSHCN Authorization Form for Non-Face-to-Face Clinician-Directed Care Coordination Services |
| Information posted October 16, 2007: The CSHCN Services Program Authorization Form for Non-Face-to-Face Clinician-Directed Care Coordination Services has been revised. The new form is available in the Provider Forms section of the TMHP website. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. Click on the title to view the revised form. |
| Sign Language Interpreter Services Now a Benefit for the CSHCN Services Program |
| Information posted October 1, 2007: Effective for dates of service on or after September 1, 2007, sign language interpreting services (procedure code 1-T1013) are a benefit of the CSHCN Services Program. Modifier U1 should be used for the first hour of service, and modifier UA should be used for each additional 15 minutes of service. Procedure code 1-T1013 billed with modifier U1 is limited to once per day, per provider. Procedure code 1-T1013 billed with modifier UA is limited to a quantity of 28 per day. Click on the title to view the details. |
| Cranial Molding Orthotics Benefit Criteria Changes |
| Information posted October 8, 2007: Effective for dates of service on or after December 1, 2007, cranial molding orthotics benefit criteria have changed for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| September 2007 |
| Provider Reimbursement Rates for CSHCN Services Program Providers |
| Information posted September 28, 2007: The Children with Special Health Care Needs (CSHCN) Services Program has implemented changes in provider reimbursement rates effective October 1, 2007. Information about these rates changes will be available in the November 2007 CSHCN Services Program Provider Bulletin, No. 64. Click on the title to view the complete list of rate changes for the CSHCN Services Program. |
| August 2007 |
| Legislative and Rate Changes Special Bulletin No. 209 |
| Information Posted August 31, 2007: The September 2007 Legislative and Rate Changes Special Bulletin No. 209 is now available. Click the title to view the bulletin.
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| New Prior Authorization Forms for CSHCN Services Program Providers |
| Information posted August 20, 2007: Effective for dates of service on or after August 3, 2007, the processing of claims and authorization requests submitted by medical foods and behavioral health providers that are covered by the Children with Special Health Care Needs (CSHCN) Services Program was transitioned from the Department of State Health Services (DSHS)-CSHCN Services Program to the TMHP-CSHCN Services Program. Medical foods providers must begin using the new Prior Authorization Request for Medical Foods form. Providers of inpatient psychiatric care must begin using the new Prior Authorization Request for Inpatient Psychiatric Care form. These forms are available on the TMHP website and will be published in the November 2007 CSHCN Services Program Provider Bulletin, No. 64. Click on the title for links to the forms. |
| CSHCN Services Program Claims Transition from DSHS to TMHP is Complete |
| Information posted August 27, 2007: The transition of claims payment from the Department of State Health Services (DSHS)-Children with Special Health Care Needs (CSHCN) Services Program to the TMHP-CSHCN Services Program has been completed. This includes claims and prior authorization requests for services previously paid by DSHS. Click on the title to view the details.
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| Correction to “2nd Qtr 2007 HCPCS Benefit Changes—CSHCN Services Program” |
| Information posted August 20, 2007: This is a correction to a website article published on June 25, 2007, titled, “2nd Quarter 2007 HCPCS Benefit Changes—CSHCN.” Information that was not included in the original article has been added. Click on the title to view the details. |
| July 2007 |
| Name Change for CSHCN Services Program Dental or Orthodontia Prior Authorization Form |
| Information posted July 23, 2007: The title for the “Request for Dental Authorization or Orthodontia Prior Authorization” form has changed for the Children with Special Health Care Needs (CSHCN) Services Program. The new title of the form is “Prior Authorization Request for Dental or Orthodontia Services.” Click on the title to view the new Prior Authorization Request for Dental or Orthodontia Services form. The form will also be available in the November 2007 CSHCN Provider Bulletin, No.64. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| NPI-Updated Forms Available Now |
| Information posted July 23, 2007: Updated forms that include the National Provider Identifier (NPI) and related data, such as the taxonomy code (if applicable), are now available. Forms currently available through the TMHP fax-back option have also been updated. The fax-back option is available by calling the Automated Inquiry System (AIS) at 1-800-925-9126 for Medicaid providers or 1-800-568-2413 for Children with Special Health Care Needs (CSHCN) Services Program providers. Click on the title to view the details.
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| Claim Submissions and Authorization Requests for Hospice Services to Transition to TMHP |
| Information posted July 23, 2007: Effective for dates of service on or after July 27, 2007, claims and authorization requests submitted by hospice services providers that are covered by the Children with Special Health Care Needs (CSHCN) Services Program will be transitioned from the Department of State Health Services (DSHS)-CSHCN Services Program to the TMHP-CSHCN Services Program. Click on the title to view the details |
| Claims and Authorization Requests for Medical Foods to Transition to TMHP |
| Information posted July 23, 2007: Effective for dates of service on or after August 3, 2007, claims and authorization requests submitted by Medical Foods providers that are covered by the Children with Special Health Care Needs (CSHCN) Services Program will be transitioned from the Department of State Health Services (DSHS)-CSHCN Services Program to the TMHP-CSHCN Services Program. Click on the title to view the details. |
| Benefits for Dental Therapeutic Services to Change for the CSHCN Services Program |
| Information posted July 14, 2007: Effective for dates of service on or after September 1, 2008, the benefit criteria for dental therapeutic services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| 2009 CSHCN Services Program Provider Manual to Be Available in May 2009 |
| Information posted December 12, 2008: The 2009 Children with Special Health Care Needs (CSHCN) Services Program Provider Manual will be mailed to providers and made available on the TMHP website at www.tmhp.com in May 2009 rather than in January as in previous years. The CSHCN Services Program has revised the production and mailing dates to be able to include policies with an implementation and an effective date through January 1, 2009 and the 2009 Healthcare Common Procedure Coding System (HCPCS) annual updates. New policy implementations and updates effective after January 1, 2009 will be published in each quarterly edition of the CSHCN Services Program Provider Bulletin.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| CSHCN Services Program Adopts Initial Rates for Additional HCPCS 2008 Procedure Codes |
| Information posted January 2, 2009: On January 1, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) has applied the annual 2008 Healthcare Common Procedure Coding System (HCPCS) updates effective for dates of service on or after January 1, 2008. Click on the title to view the details. |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List Information |
| Information posted January 7, 2009: The Children with Special Health Care Needs (CSHCN) Services Program has removed 314 clients from the program's waiting list. The effective date of this removal is January 1, 2009. These new clients received a gray CSHCN Services Program Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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| CSHCN Services Program Benefit Changes for Drug Procedure Codes J1645, J1650, and J1652 |
| Information posted January 9, 2009: Procedure codes J1645, J1650, and J1652 will be reimbursable in office, home, nursing home and outpatient settings. Effective February 1, 2009, procedure codes 1-J1645, 1-J1650, and 1-J1652 will be payable in the office, home, nursing home, and outpatient hospital setting for nurse practitioners, clinical nurse specialists, physicians, and physician groups. Procedure codes 1-J1645, 1-J1650, and 1-J1652 will also be payable to hospitals in an outpatient hospital setting.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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| New CSHCN Reimbursement Rates for Nutritional Products, Equipment, and Supplies |
| Information posted January 9, 2009: Effective for dates of service on or after January 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program has implemented reimbursement rates for nutritional products, equipment, and supplies. Click on the title to view the details.
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| Unit Calculations for Billing Drugs |
| Information posted January 9, 2009: Reminder: Providers that request reimbursement for drugs must bill the number of units based on the number of Healthcare Common Procedure Coding System (HCPCS) units actually administered. Providers should refer to the HCPCS procedure code description for the unit amount to calculate the number of units to be billed. Click on the title to view the details. |
| February 2009 CSHCN Provider Bulletin No. 69 |
| Information Posted January 14, 2009: The February 2009 CSHCN Provider Bulletin No. 69 is now available. Click the title to view the bulletin.
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| Updated Information for Outpatient Speech-Language Pathology & Physical Medicine and Rehabilitation |
| Information posted January 21, 2009: This is an update to a banner message that appeared on the January 16, 2009, Remittance and Status (R&S) Report about outpatient speech-language pathology and physical medicine and rehabilitation, the corresponding article that was published on this website January 9, 2009, titled "Update for Outpatient Speech-Language Pathology and Physical Medicine and Rehabilitation," and articles published in the February 2009 CSHCN Services Program Provider Bulletin, No. 69, titled “Change in Benefit Criteria for Outpatient Speech-Language Pathology Services” and “Change in Benefit Criteria for Physical Medicine and Rehabilitation Services.” Click on the title to view the updated information.
Article:
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| Hurricane Ike Filing Deadline Waiver for CSHCN Services Program Providers to Be Discontinued |
| Information posted January 22, 2009: Effective February 1, 2009, TMHP will discontinue the filing deadline waiver for services rendered to Children with Special Health Care Needs (CSHCN) Service Program clients in ZIP codes affected by Hurricane Ike. Click on the title to view the details. |
| CSHCN Services Program Rates to Change for Casting, Splinting, and Strapping Services |
| Information posted January 30, 2009: Effective for dates of service on or after March 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates will change for casting, splinting, and strapping services for surgery, assistance surgery, and ambulatory surgical centers. Click on the title to view the details. |
| CSHCN Services Program Benefits Have Changed for Some Durable Medical Equipment (DME) |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, benefit criteria for the Children with Special Health Care Needs (CSHCN) Services Program will change for some durable medical equipment (DME). Click on the title to view the details.
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| Update to CSHCN Services Program Adopts Rates for More HCPCS 2008 Procedure Codes |
| Information posted February 6, 2009: This is a clarification to a banner message that first appeared on the January 9, 2009, Remittance and Status (R&S) Report, and to an article that was published on this website on January 2, 2009, titled “CSHCN Services Program Adopts Initial Rates for More HCPCS 2008 Procedure Codes.” Click on the title to view the details.
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| Update to CSHCN Services Program Rate Changes for Nutritional Products, Equipment, and Supplies |
| Information posted February 6, 2009: Effective for dates of service on or after January 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates have changed for nutritional products, equipment, and supplies. Click on the title to view the details.
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| Clarification: Claims Filing Deadline Waived for Providers in Ike Evacuation Areas |
| Information posted February 6, 2009: This is a clarification to an article posted to the Children with Special Health Care Needs (CSHCN) Services Program web page on September 24, 2008, titled, “CSHCN Services Program Claim Filing Deadline Waived for Services to Ike Evacuees.” Click on the title to view the details.
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| Technetium TC 99M Correction Article |
| Information posted February 13, 2009: This is a correction to a banner message that was published on November 23, 2007. The banner message incorrectly stated that procedure codes A9500 and A9502 are limited to 3 per day, any provider. The correct statement is as follows:
Procedure codes 9-A9500 and 9-A9502 are limited to 3 per day, same provider.
For more information, call the TMHP CSHCN Services Program Contact Center at 1-800-568-2413.
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| Update to TMHP Scheduled System Maintenance for March 8, 2009 |
| Information posted February 20, 2009: This is an update to the announcement of scheduled system maintenance for Sunday March 8, 2009. The outage window for March 8, 2009, will be extended by two hours from 6:00 p.m. until 2:00 a.m. on Monday, March 9, 2009, to allow for the performance of additional operating system maintenance. Some functions will be unavailable during this time period. Click on the title to view the details. |
| CSHCN Rate Changes for Ambulatory Surgical Centers, Dental, and DME Services |
| Information posted February 20, 2009: Effective for dates of service on or after April 1, 2008, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates for 2008 HCPCS procedure codes have changed for ambulatory surgical centers, dental, and durable medical equipment (DME) services. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details.
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| Correction to Rate Changes Insert in the November 2007 CSHCN Services Program Provider Bulletin |
| Information posted February 20, 2009: This is a correction to the Rate Changes Insert in the November 2007 CSHCN Services Program Provider Bulletin, No. 64. The “Rate Changes for Anesthesia Services” article on page 25 and “Rate Increases for Physician and Other Professional Services” article on page 26 indicated that some procedure codes were not a benefit of the CSHCN Services Program and so were not affected by the rate change. Some of these procedure codes are benefits of the CSHCN Services Program and should have had the rate increase applied to them. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.
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| Medical Home Implementation Teleconference Series Scheduled for March 2009 through June 2009 |
| Information posted February 27, 2009: The American Academy of Pediatrics is hosting a free teleconference series that begins in March 2009 and runs through June 2009 to provide child health professionals with practical strategies for implementing the medical home concept in their practices. Click on the title to view the complete article.
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| CSHCN Services Program Benefits to Change for Telemedicine Services |
| Information posted February 27, 2009: Effective for dates of service on or after April 1, 2009, benefit criteria for telemedicine services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| New Benefits for Home Health Services for the CSHCN Services Program |
| Information posted March 6, 2009: Effective for dates of service on or after May 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program will implement new benefit criteria for home health services. Click on the title to view the details. |
| 2009 CSHCN Manual Correction to Telephone Numbers for Regions 9 and 10 |
| Information posted June 19, 2009: This is a correction to the 2009 CSHCN Services Program Provider Manual, section 1.2.2.9 Regions 9 and 10 titled “TMHP and DSHS Contact Information” On page 1-14. The manual lists an incorrect telephone number for the Midland Office (Region 9). The correct telephone number is 1-432-571-4759.
The manual also lists an incorrect telephone number for San Angelo (Region 9). Region 9 should list Joanne Mundy at 1-432-571-4151 as the Case Management Consultant for both the Midland and San Angelo offices.
The El Paso information is correct for Region 10.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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| June 2007 |
| Grace Period for CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis) |
| Information posted June 27, 2008: This is an update to a banner message that was published in the April 11, 2008, Remittance and Status (R&S) report about the revised CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis). TMHP is allowing a 90-day grace period during which the previous form is accepted for processing by TMHP. Effective September 1, 2008, prior authorization requests submitted on the old form will be returned to the provider with instructions to submit the request on the revised form. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| CSHCN Opticians and Doctors of Optometry Claims and Authorization Requests Delayed Until July 13 |
| Information posted June 25, 2007: This is a correction to an article that first appeared on website on May 14, 2007. The article stated that effective for dates of service on or after July 6, 2007, claims and authorization requests that are submitted by opticians and doctors of optometry who are covered by the Children with Special Health Care Needs (CSHCN) Services Program will be transitioned from the Department of State Health Services (DSHS)-CSHCN to TMHP-CSHCN. Although the effective date for the transition is July 6, 2007, TMHP has determined that system implementation will take place on July 13, 2007. Opticians and doctors of optometry must wait until July 13, 2007, to submit claims and authorization requests to TMHP-CSHCN. Ophthalmologists can continue to submit claims and prior authorization requests to TMHP. For more information, call the TMHP-CSHCN Contact Center at 1-800-568-2413. |
| CRNA Services for the CSHCN Services Program to Transition to TMHP |
| Information posted June 11, 2007: Effective for dates of service on or after August 03, 2007, claims and authorization requests for certified registered nurse anesthetist (CRNA) services that are covered by the Children with Special Health Care Needs (CSHCN) Services Program will be transitioned from the Department of State Health Services (DSHS)-CSHCN to TMHP-CSHCN. Click on the title to view the details. |
| 2nd Quarter 2007 HCPCS Benefit Changes—CSHCN |
| Information posted June 25, 2007: Second quarter 2007 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after July 1, 2007, for the Children with Special Health Care Needs (CSHCN) Services Program are now available on the 2007 HCPCS webpage of the TMHP website at www.tmhp.com. Deleted procedure codes will no longer be benefits of the CSHCN Services Program effective for dates of service on or after July 1, 2007. Click on the title to view the details. |
| CSHCN Opticians and Doctors of Optometry Claims and Authorization Requests Delayed Until July 13 |
| Information posted June 25, 2007: This is a correction to an article that first appeared on website on May 14, 2007. The article stated that effective for dates of service on or after July 6, 2007, claims and authorization requests that are submitted by opticians and doctors of optometry who are covered by the Children with Special Health Care Needs (CSHCN) Services Program will be transitioned from the Department of State Health Services (DSHS)-CSHCN to TMHP-CSHCN. Although the effective date for the transition is July 6, 2007, TMHP has determined that system implementation will take place on July 13, 2007. Opticians and doctors of optometry must wait until July 13, 2007, to submit claims and authorization requests to TMHP-CSHCN. Ophthalmologists can continue to submit claims and prior authorization requests to TMHP. For more information, call the TMHP-CSHCN Contact Center at 1-800-568-2413. |
| May 2007 |
| CSHCN Rate Changes for PET and CT Codes |
| Information posted May 28, 2007: Effective for dates of service on or after June 18, 2007, the reimbursement rates to Children with Special Health Care Needs (CSHCN) Services Program providers will change for positron emission tomography (PET) and computed tomography (CT) procedure codes. Click on the title to view the details. |
| April 2007 |
| Correction to “CSHCN Renal Dialysis Services to Transition to TMHP” Article |
| Information posted April 9, 2007: This is a correction to a website article that was published on the TMHP website on March 12, 2007, about the Children with Special Health Care Needs (CSHCN) Services Program renal dialysis services transitioning to TMHP. The article incorrectly listed B-825 as a payable code and also stated that equipment services for Method II are separately reimbursable for hemodialysis supplies. Neither of these benefits will be effective with the implementation of renal dialysis services on May 4, 2007. The Prior Authorization Request for Renal Dialysis Treatment form has been updated accordingly. The article has also been updated to include additional information regarding coverage of ultrafiltration. Click on the title to view the complete, corrected article. |
| Additional Claims Information About CSHCN Services Transitioning to TMHP-CSHCN |
| Information posted April 23, 2007: The following provides additional information for previously published articles about the transition of advanced practice nurses, respiratory therapists, renal dialysis, genetics, and augmentative communication devices services of the Children with Special Health Care Needs (CSHCN) Services Program from Department of State Health Services (DSHS)-CSHCN to TMHP-CSHCN. Click on the title to view the details. |
| March 2007 |
| CSHCN Renal Dialysis Services to Transition to TMHP |
| Information posted March 12, 2007: Effective for dates of service on or after May 4, 2007, claims processing and authorizations for renal dialysis services that are covered by the Children with Special Health Care Needs (CSHCN) Services Program will be transitioned from the Department of State Health Services (DSHS)-CSHCN to TMHP-CSHCN. In addition, benefit changes for renal dialysis services will become effective on that date. Click on the title to view the details. |
| February 2007 |
| Critical Care Services Benefit Changes for the CSHCN Services Program |
| Information posted February 23, 2007 - Effective for dates of services on or after April 1, 2007, the criteria for the critical care services benefits have changed for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| January 2007 |
| Correction to the 2007 CSHCN Services Program Provider Manual Part I CD Cover |
| Information posted January 15, 2007: The 2007 CSHCN Services Program Provider Manual Part I was mailed on compact disc (CD) to all currently enrolled CSHCN providers in January 2007. The CD contains an electronic version of the manual in Adobe® Portable Document Format (PDF). To view and use the manual, providers must have Adobe Reader software, which is available as a free download from the Adobe website. Please note the correct address for the Adobe website is www.adobe.com. TMHP’s website address was inadvertently printed on the CD packaging. Providers who have not received the 2007 CSHCN Services Program Provider Manual Part I can request a CD by calling the TMHP-CSHCN Contact Center at 1-800-568-2413.
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| Correction to the Cytogenetic Testing Benefit Changes for the CSHCN Services Program |
| Information posted January 29, 2007: The following is a correction to an article published on the TMHP website on December 11, 2006, entitled "New Benefits for Cytogenetics Testing for the CSHCN Services Program.” The following diagnosis codes should have been included as eligible for reimbursement: 20290, 20400, 20401, 20410, 20411, 20420, 20421, 20480, 20481, 20490, 20491, 20580, 20690, 20691, 20890, 29900, 29901, 31400, 31401, 31509, 52400, 52401, 52402, 52403, 52404, 52405, 52406, 52407, 52409, 74100, 74191, 74192, 74193, 74789, 7509, 75219, V2631, V2632, and V2633. Click on the title to view the complete, corrected article. |
| December 2006 |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List |
| Information posted December 4, 2006: On December 2, 2006, the Children with Special Health Care Needs (CSHCN) Services Program removed 143 clients from the program's waiting list. The effective date of this removal is November 1, 2006. These new clients received a gray CSHCN Eligibility Form that indicates the dates they are eligible to receive CSHCN covered services. When scheduling a client for an appointment, ask them to bring the form to their appointment so that a copy can be made for your records. Click on the title for details. |
| Changes to Procedure Codes Payable for Vitiligo Diagnosis Code |
| Information posted December 11, 2006: Effective December 1, 2006 for dates of service on or after December 1, 2003, diagnosis code 70901 (Vitiligo) is payable for procedure codes 2-96920, 2-96921, and 2-96922.
Claims submitted for dates of service on or after December 1, 2003 that include procedure 2-96920, 2-96921, and 2-96922 with diagnosis 70901 will be reprocessed and payments adjusted accordingly. No action on the part of the providers is necessary.
For more information, call the TMHP Contact Center at 1-800-568-2413.
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| Benefit Changes to CSHCN Reimbursement for Ambulatory Encephalogram |
| Information posted December 22, 2006: Effective for dates of service on or after February 1, 2007, procedure codes 5/I/T-95950, 5/I/T-95951, 5/I/T-95953, and 5/I/T-95956 may be considered for reimbursement by the Children with Special Health Care Needs (CSHCN) Services Program when submitted with diagnosis codes: 2930, 2948, 7797, and 78039.
Procedure codes 5/I/T-95950, 5/I/T-95951, 5/I/T-95953, and 5/I/T-95956 will no longer be considered for reimbursement by the CSHCN Services Program when submitted with diagnosis codes: 34830, 34831, 34839, 76711, 76719, V7649, V7681, V7689, and V800.
Additionally, ambulatory electroencephalograms are limited to three per six months, for each provider, for the same client.
For more information call the TMHP-CSHCN Contact Center at 1-800-568-2413.
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| October 2006 |
| Correction to Therapeutic Dental Procedures Changing for CSHCN Providers |
| This is a correction to the article published on the TMHP website at www.tmhp.com on October 6, 2006, about changes to the therapeutic dental policy for the Children with Special Health Care Needs (CSHCN) Services Program. The article incorrectly stated that the following procedure codes were a benefit of the CSHCN Services Program: D2712, D2799, D3221, D4220, D5867, D5875, D6982, D7412, D7415, D7473, D7482, D7490, D7671, and D9970. Click the title to view the complete and corrected article. |
| Correction to Rotavirus and Tdap Vaccine Benefit Update Article for CSHCN Providers |
| Information posted October 23, 2006: This is a correction to an article that first appeared on October 6, 2006, about benefit changes for Rotavirus and the combined tetanus, diphtheria, and pertussis (Tdap) vaccines. The article included incorrect dates of service for the Tdap vaccine. Click the title to view the complete, corrected article. |
| August 2006 |
| CSHCN Needs You |
| Information Posted August 25, 2006: The Children with Special Health Care Needs (CSHCN) Services Program needs you. The program is always in need of caring, qualified providers who can deliver much needed medical services to some very special Texas children. Click the title for more information and instructions on how to enroll in this special program.
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| July 2006 |
| 2006 HCPCS 2nd Quarter Update |
| Information Posted on July 3, 2006: Beginning July 12, 2006, effective for dates of service on or after July 1, 2006, TMHP will implement the 2006 Healthcare Common Procedure Coding System (HCPCS) first quarter update for the Texas Medicaid and Children with Special Health Care Needs (CSHCN) Services Programs. Click the title to view the details.
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| February 2006 |
| Changes to Neurostimulator Reimbursement for Medicaid and CSHCN Providers |
| Effective for dates of service on and after February 1, 2006, pulse generation devices and electrodes for sacral and vagal nerve stimulators will be payable in addition to the associated implantation/revision procedures. Click on the title for complete details. |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List |
| Effective February 1, 2006, the Children with Special Health Care Needs (CSHCN) Services Program removed 90 clients from the program’s waiting list. These clients received a gray CSHCN Eligibility Form that indicates the dates they are eligible to receive CSHCN covered services. When scheduling a client for an appointment, ask them to bring the form to their appointment so that a copy can be made for your records.
Click on the title for complete details.
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| 2005 |
| Attention CSHCN Providers: Synagis® Available to Physicians through the Vendor Drug Program |
| Beginning October 14, 2005, Synagis® will be available to physicians for administering to CSHCN clients through the Vendor Drug Program (VDP). This new option enables physicians to have Synagis® shipped directly to their office from a network pharmacy. Physicians will not need to purchase the drug. Providers that obtain Synagis® through the VDP may not bill CSHCN for the drug. Click on the title to view the full article. |
| 2005 CSHCN Provider Manual |
| The 2005 CSHCN Provider Manual is now available for download from the TMHP.com file library. |
| 2004 |
| April 2004 CSHCN Newsletter for Families |
| The April 2004 CSHCN Newsletter for Families (English and Spanish) is now available for download from the TMHP.com file library. |