CSHCN Services Program 2010 > Authorizations and Prior Authorizations > Authorizations

    
 

4.2.1 Services that Require Authorization

The following is a list of many of the services that require authorization. The list below is not all-inclusive. Information about specific authorization requirements for each of the services that is a benefit of the CSHCN Services Program is included in the chapter for each service. Refer to the specific provider sections in this manual or call TMHP at 1-800-568-2413 for more information.

Ambulatory Surgeries Performed at a Freestanding Facility or as Outpatient Hospital Day Surgeries
Refer to:

Section 23.5, "Ambulatory Surgical Centers".

Use:

The "CSHCN Services Program Prior Authorization and Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons" form on page B-80.

Exception:

Does not include procedures listed in Section 4.3.1, "Services that Require Prior Authorization".

Blood Pressure Devices, In Specific Instances
Refer to:

Chapter 11, "Blood Pressure Devices and Supplies,".

Use:

The "CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)" form on page B-30.

Botulinum Toxin (Type A and B)
Refer to:

Section 30.2.24.5, "Botulinum Toxin (Type A and Type B)".

Use:

The "CSHCN Services Program Prior Authorization and Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons" form on page B-80.

Clinician-Directed Care Coordination Services
Refer to:

Section 30.2.12, "Clinician-Directed Care Coordination Services".

Use:

The "CSHCN Services Program Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordinated Services" form on page B-87.

Durable Medical Equipment (DME)
Refer to:

Chapter 17, "Durable Medical Equipment (DME),".

Use:

The "CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)" form on page B-30.

Exception:

Custom DME and more complex equipment requires prior authorization.

Hemophilia Blood Factor Products
Refer to:

Section 30.2.8, "Blood Factor Products".

Use:

The "CSHCN Services Program Authorization Request for Hemophilia Blood Factor Products" form on page B-84.

Home Health (Skilled Nursing Only) Up to 200 Hours Per Calendar Year
Refer to:

Chapter 21, "Home Health (Skilled Nursing) Care,".

Use:

The "CSHCN Services Program Home Health (Skilled Nursing) Referral and Treatment Plan" form on page B-108.

Nebulizers, In Specific Instances
Refer to:

Section 33.2.8, "Nebulizers".

Use:

The "CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)" form on page B-30.

Orthotics and Prosthetics
Refer to:

Chapter 27, "Orthotic and Prosthetic Devices,".

Use:

The "CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)" form on page B-30.

Outpatient Dental Surgical Procedures
Refer to:

Section 14.2.6, "Dental Treatment in Hospitals and ASCs".

Use:

The "CSHCN Services Program Prior Authorization and Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons" form on page B-80.

Use:

The "CSHCN Services Program Prior Authorization Request for Dental or Orthodontia Services" form on page B-22.

Use:

The "CSHCN Services Program Criteria for Dental Therapy Under General Anesthesia" form on page B-101.

Outpatient Physical Therapy and Occupational Therapy Services
Refer to:

Section 29.2.2, "Physical Medicine, Physical Therapy (PT), and Occupational Therapy (OT)".

Use:

The "CSHCN Services Program Authorization Request for Initial Outpatient Therapy (TP1)" form on page B-97.

Use:

The "CSHCN Services Program Authorization Request for Extension of Outpatient Therapy (TP2)" form is located on page B-93.

Prescription Shoes
Refer to:

Section 27.3.6, "Prescription Shoes and Lifts".

Use:

The "CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)" form is located on page B-30.

Outpatient Speech-Language Pathology Services (all services except initial evaluations)
Refer to:

Chapter 34, "Speech-Language Pathology (SLP) Services".

Use:

The "CSHCN Services Program Authorization Request for Initial Outpatient Therapy (TP1)" form on page B-97.

Use:

The "CSHCN Services Program Authorization Request for Extension of Outpatient Therapy (TP2)" form is located on page B-93.

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