3.3 Services/Benefits, Limitations, and Prior Authorization
CPW services are limited to 1 contact per day per client. Additional provider contacts on the same day are denied as part of another service rendered on the same day.
The procedure code to be used for all CPW services is G9012. Modifiers are used to identify which service component is provided.
Service
Contact Code
Comprehensive visit
G9012 with modifier U5 and modifier U2
Follow-up face-to-face
G9012 with modifier U5 and modifier TS
Follow-up telephone
G9012 with modifier TS
Providers must adhere to CPW case management program rules, policies, and procedures.
Note: CPW providers are not required to file claims with other health insurance before filing with Medicaid.
Reminder: Billable services are defined in program rule 25 TAC §27.5.
CPW services are not billable when a client is an inpatient at a hospital or other treatment facility.
Reimbursement will be denied for services rendered by providers who have not been approved by the DSHS Health Screening and Case Management Unit.
Texas Medicaid & Healthcare Partnership CPT only copyright 2009 American Medical Association. All rights reserved.
