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Texas Medicaid (Title XIX) Home Health Services
24.1 Enrollment 24-4
24.1.1 Change of Address/Telephone Number 24-4
24.1.2 Pending Agency Certification 24-4
24.2 Medicaid Managed Care Enrollment 24-5
24.3 Reimbursement 24-5
24.3.1 Eligibility 24-5
24.3.1.1 Retroactive Eligibility 24-6
24.3.1.2 Authorization of Retroactive Eligibility 24-6
24.3.2 Prior Authorization 24-6
24.4 Home Health Services 24-7
24.4.1 Client Evaluation 24-7
24.4.2 Physician Supervision-Plan of Care 24-7
24.4.2.1 Written Plan of Care 24-7
24.5 Benefits 24-8
24.5.1 Home Health Skilled Nursing Services 24-9
24.5.1.1 Skilled Nursing Visits 24-9
24.5.2 Home Health Aide Services 24-11
24.5.2.1 Home Health Aide Visits 24-11
24.5.2.2 Supervision of Home Health Aides 24-11
24.5.3 Home Health Skilled Nursing and Home Health Aides Services
Provider Responsibilities 24-12
24.5.4 Home Health Skilled Nursing and Home Health Aide Services
Prior Authorization Requirements 24-12
24.5.4.1 Canceling an Authorization 24-13
24.5.4.2 Home Health Skilled Nursing Services and Home Health
AIDE Services that will not be Prior Authorized 24-13
24.5.5 Home Health Skilled Nursing and Home Health Aide Services
Assessments and Reassessments 24-13
24.5.6 Supplies Submitted with a Plan of Care 24-14
24.5.7 Medication Administration Limitations 24-14
24.5.8 Physical Therapy (PT) Services 24-14
24.5.8.1 Physical Therapy Prior Authorization Procedures 24-15
24.5.8.2 Limitations 24-15
24.5.9 Physical Therapy/Occupational Therapy Procedure Codes 24-15
24.5.10 Occupational Therapy (OT) Services 24-16
24.5.10.1 Occupational Therapy Prior Authorization Procedures 24-16
24.5.11 Medical Supplies 24-16
24.5.11.1 Supply Procedure Codes 24-18
24.5.11.2 Canceling an Authorization 24-18
24.5.12 Diabetic Supplies/Equipment 24-18
24.5.12.1 Blood Testing Supplies 24-19
24.5.12.2 Blood Glucose Monitors 24-19
24.5.12.3 Insulin and Insulin Syringes 24-20
24.5.12.4 Insulin Pump 24-20
24.5.13 Incontinence Supplies and Equipment 24-21
24.5.13.1 Incontinence Supplies 24-21
24.5.13.2 Incontinence Equipment 24-22
24.5.13.3 Incontinence Procedure Codes With Limitations 24-23
24.5.14 Wound Care Supplies and/or Systems 24-25
24.5.14.1 Wound Care Supplies 24-25
24.5.14.2 Wound Care System 24-26
24.5.14.3 Thermal Wound Care System 24-26
24.5.14.4 Sealed Suction Wound Care System 24-26
24.5.14.5 Pulsatile Jet Irrigation Wound Care System 24-27
24.5.14.6 Wound Care System Criteria 24-27
24.5.14.7 Prior Authorization 24-27
24.5.14.8 Wound Care Procedures and Limitations 24-28
24.5.15 Durable Medical Equipment (DME) and Supplies 24-29
24.5.16 Augmentative Communication Device (ACD) System 24-32
24.5.16.2 Prior Authorization and Required Documentation 24-32
24.5.16.3 Procedure Codes for ACD Systems and Accessories 24-33
24.5.16.4 ACD System Accessories 24-34
24.5.16.5 Noncovered ACD System Items 24-34
24.5.16.6 Prior Authorization 24-34
24.5.16.7 Trial Period/Rental/Purchase 24-35
24.5.16.8 DME Certification 24-35
24.5.16.9 Reimbursement 24-35
24.5.16.10 Nonwarranty Repairs 24-35
24.5.16.12 ACD Procedure Codes and Limitations 24-36
24.5.17 Bath and Bathroom Equipment 24-36
24.5.18 Blood Pressure Devices 24-39
24.5.19 Breast Pumps 24-39
24.5.20 Continuous Passive Motion (CPM) Device 24-39
24.5.21 Intravenous (IV) Therapy Equipment and Supplies 24-39
24.5.22 Phototherapy Devices 24-42
24.5.23 Hospital Beds and Equipment 24-43
24.5.23.1 Criteria for Grouping Levels 24-44
24.5.23.2 Decubitus Care Accessories 24-47
24.5.23.3 Hospital Beds and Equipment Procedure Code Table 24-47
24.5.24 Reflux Slings and Wedges 24-48
24.5.25 Special Needs Car Seats and Travel Restraints 24-48
24.5.26 Mobility Aids 24-48
24.5.26.1 Canes, Crutches, and Walkers 24-48
24.5.26.2 Feeder Seats, Floor Sitters, Corner Chairs, and Travel Chairs 24-48
24.5.26.4 Seating Assessment for Manual and Power Custom Wheelchairs 24-49
24.5.26.5 Manual Wheelchairs-Custom 24-49
24.5.26.6 Levels for Custom Manual and Powered Wheelchairs 24-49
24.5.26.7 Power Wheelchairs-Standard 24-49
24.5.26.8 Power Wheelchairs-Custom 24-50
24.5.26.11 Hydraulic Lift 24-51
24.5.26.15 Batteries and Battery Charger 24-51
24.5.26.21 Wheelchair Ramp-Portable and Threshold 24-52
24.5.26.22 Procedure Codes and Limitations for Mobility Aids 24-52
24.5.27 Respiratory Equipment and Supplies 24-57
24.5.27.3 Humidification Units 24-58
24.5.27.4 Secretion Clearance Devices 24-58
24.5.27.5 Electrical Percussor 24-59
24.5.27.6 Chest Physiotherapy Devices 24-59
24.5.27.7 Positive Airway Pressure System Devices 24-61
24.5.27.8 Continuous Positive Airway Pressure (CPAP) System 24-61
24.5.27.9 Pediatric CPAP Changes 24-61
24.5.27.10 CPAP Prior Authorization Renewal 24-61
24.5.27.11 Bi-level Positive Airway Pressure System (BiPAP S) Without Backup 24-62
24.5.27.12 Bi-level Positive Airway Pressure System With Backup (BiPAP ST) 24-62
24.5.27.13 Volume Ventilators 24-63
24.5.27.14 Negative Pressure Ventilators 24-63
24.5.27.15 Ventilator Service Agreement 24-63
24.5.27.16 Oxygen Therapy 24-64
24.5.27.17 Initial Oxygen Therapy Medical Necessity Certification 24-64
24.5.27.18 Oxygen Therapy Recertification 24-65
24.5.27.19 Oxygen Therapy Home Delivery System Types 24-65
24.5.27.20 Tracheostomy Tubes 24-65
24.5.27.21 Pulse Oximetry 24-65
24.5.27.22 Procedure Codes and Limitations for Respiratory
Equipment and Supplies 24-65
24.5.28 Procedure Codes That Do Not Require Prior Authorization 24-67
24.5.29 Nutritional (Enteral) Products, Supplies, and Equipment 24-67
24.5.29.1 Nutritional Products and Supplies 24-67
24.5.29.2 Enteral Nutritional Products 24-68
24.5.29.3 Enteral Feeding Pumps 24-69
24.5.30 Limitations, Exclusions 24-69
24.6 Medicaid Relationship to Medicare 24-70
24.6.1 Possible Medicare Clients 24-70
24.6.2 Benefits for Medicare/Medicaid Clients 24-71
24.6.3 Medicare/Medicaid Authorization 24-71
24.6.4 Medicare/Medicaid Authorization and Reimbursement 24-71
24.7 Prohibition of Medicaid Payment to Home Health Agencies Based on Ownership 24-72
24.8 Claims Information 24-72
24.9 Claim Filing Resources 24-73
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