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6.3.50 Physician Evaluation and Management (E/M) Services
E/M is a benefit of Texas Medicaid. E/M is divided into categories and subcategories. Medical documentation for E/M must consist of the appropriate components as designated in the 1995 and 1997 Physician Evaluation and Management guidelines published by CMS and in the CPT manual.
The following E/M services are benefits of Texas Medicaid:
• Domiciliary, rest home, or custodial care services
•Emergency department services
•Group clinical visits
•Home services
•Hospital services including inpatient, observation, critical care, discharge, and concurrent care services (includes consultation and prolonged services)
•Nursing facility services
•Office or other outpatient services for new and established patients (includes consultation and prolonged services)
•Preventive care visits
•Services outside of business hours
Claims submitted to TMHP by physicians for services provided during an inpatient hospital stay must be received by TMHP within 95 days of each date of service, not 95 days of the discharge date.
Inpatient claims must indicate the facility's provider identifier in Block 32 or in the appropriate field of electronic software.
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