TMPPM 2008 > Texas Medicaid Services > Texas Health Steps (THSteps) > THSteps-Comprehensive Care Program (CCP)

43.4.7.3 Benefits and Limitations

Only providers enrolled as licensed dietitians are eligible for reimbursement for dietitian services.

THSteps-CCP is for Medicaid THSteps-eligible clients birth through 20 years of age. THSteps-CCP eligibility ends on the client's 21st birthday. If the client's Medicaid ID states "Emergency Care," "PE," or "QMB," the client is not eligible for THSteps or THSteps-CCP benefits. THSteps-CCP may cover nutrition assessment and/or counseling to prevent, treat, or minimize the effects of illness, injury, or other impairments.

Nutrition services may be a benefit when:

•The client is THSteps-CCP eligible.

•Prescribed by a physician.

•Medically necessary.

•Completed by a Medicaid-enrolled dietitian licensed by the Texas State Board of Examiners of Dietitians.

•Completed in the home or office.

Prior authorization is not required for two nutrition assessments per year or for four nutrition counseling visits per year. Providers are responsible for maintaining documentation to support medical necessity in the client's clinical record. A request for authorization must include documentation from the provider to support the medical necessity of the service, equipment, or supply.

Prior authorization is required for more than two assessments or more than four nutrition counseling visits per year. Submit these requests with written documentation to support medical necessity. A request for authorization must include documentation from the provider to support the medical necessity of the service, equipment, or supply.

Note: Prior authorization is a condition for reimbursement, not a guarantee of payment.

To request prior authorization or submit claims, providers must use the procedure code 1-S9470 with a maximum fee of $30.45 and procedure code 1-97802 or 1-97803 with a maximum fee of $10.15 per 15 minutes.

If 1-S9470 and either 1-97802 or 1-97803 are billed for the same date of service, 1-97802 or 1-97803 is paid and 1-S9470 is denied.

Physician Signature

The physician's signature, required on a prescription and the THSteps-CCP Prior Authorization Request Form, must be current to the service date of the request.

Refer to: "Physician Signature" for complete information about this requirement.