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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 Reimbursement 24-5
24.2.1 Eligibility 24-5
24.2.1.1 Retroactive Eligibility 24-5
24.2.1.2 Prior Authorization of Retroactive Eligibility 24-5
24.2.2 Prior Authorization 24-5
24.3 Home Health Services 24-6
24.3.1 Client Evaluation 24-6
24.3.2 Physician Supervision-POC 24-7
24.3.2.1 Written POC 24-7
24.4 Benefits 24-8
24.4.1 Home Health Skilled Nursing (SN) Services 24-8
24.4.2 Home Health Aide (HHA) Services 24-10
24.4.2.1 HHA Visits 24-10
24.4.2.2 Supervision of HHA 24-11
24.4.3 Home Health SN and HHA Services Provider Responsibilities 24-11
24.4.4 Home Health SN and HHA Services Prior Authorization Requirements 24-11
24.4.4.1 Canceling a Prior Authorization 24-13
24.4.4.2 Home Health SN Services and HHA Services That Will
Not Be Prior Authorized 24-13
24.4.5 Home Health SN and HHA Services Assessments and Reassessments 24-13
24.4.6 Supplies Submitted with a POC 24-13
24.4.7 Medication Administration Limitations 24-14
24.4.8 Physical Therapy (PT) Services 24-14
24.4.8.1 PT Prior Authorization Procedures 24-14
24.4.8.2 PT/OT Limitations 24-15
24.4.9 PT/OT Procedure Codes 24-15
24.4.10 Occupational Therapy (OT) Services 24-15
24.4.10.1 OT Prior Authorization Procedures 24-16
24.4.11 Medical Supplies 24-16
24.4.11.1 Supply Procedure Codes 24-17
24.4.11.2 Canceling a Prior Authorization 24-17
24.4.12 Diabetic Supplies/Equipment 24-18
24.4.12.1 Blood Testing Supplies 24-18
24.4.12.2 Blood Glucose Monitors 24-19
24.4.12.3 Insulin and Insulin Syringes 24-19
24.4.12.4 Insulin Pump 24-20
24.4.13 Incontinence Supplies and Equipment 24-20
24.4.13.1 Incontinence Supplies 24-21
24.4.13.2 Incontinence Equipment 24-22
24.4.13.3 Incontinence Procedure Codes With Limitations 24-23
24.4.14 Wound Care Supplies and/or Systems 24-25
24.4.14.1 Wound Care Supplies 24-25
24.4.14.2 Wound Care System 24-25
24.4.14.3 Thermal Wound Care System 24-25
24.4.14.4 Sealed Suction Wound Care System 24-26
24.4.14.5 Pulsatile Jet Irrigation Wound Care System 24-26
24.4.14.6 Wound Care System Criteria 24-26
24.4.14.7 Prior Authorization 24-26
24.4.14.8 Wound Care Procedures and Limitations 24-27
24.4.15 Durable Medical Equipment (DME) and Supplies 24-28
24.4.16 Augmentative Communication Device (ACD) System 24-31
24.4.16.2 Prior Authorization and Required Documentation 24-32
24.4.16.3 Non-Covered ACD System Items 24-33
24.4.17 Bath and Bathroom Equipment 24-34
24.4.18 Blood Pressure Devices 24-37
24.4.19 Breast Pumps 24-37
24.4.20 Cochlear Implants 24-38
24.4.21 Continuous Passive Motion (CPM) Device 24-38
24.4.22 Intravenous (IV) Therapy Equipment and Supplies 24-38
24.4.23 Phototherapy Devices 24-40
24.4.23.1 Retroactive Eligibility 24-41
24.4.24 Hospital Beds and Equipment 24-41
24.4.24.2 Pressure-Reducing Support Surfaces 24-42
24.4.24.3 Criteria for Grouping Levels 24-42
24.4.24.4 Decubitus Care Accessories 24-44
24.4.24.5 Hospital Beds and Equipment Procedure Code Table 24-45
24.4.25 Reflux Slings and Wedges 24-45
24.4.26 Special Needs Car Seats and Travel Restraints 24-46
24.4.27 Mobility Aids 24-46
24.4.27.1 Canes, Crutches, and Walkers 24-46
24.4.27.2 Feeder Seats, Floor Sitters, Corner Chairs, and Travel Chairs 24-46
24.4.27.4 Seating Assessment for Manual and Power Custom Wheelchairs 24-47
24.4.27.5 Manual Wheelchairs-Custom 24-47
24.4.27.6 Levels for Custom Manual and Powered Wheelchairs 24-47
24.4.27.7 Power Wheelchairs-Standard 24-47
24.4.27.8 Power Wheelchairs-Custom 24-48
24.4.27.9 Batteries and Battery Charger 24-48
24.4.27.12 Hydraulic Lift 24-49
24.4.27.21 Wheelchair Ramp-Portable and Threshold 24-50
24.4.27.22 Procedure Codes and Limitations for Mobility Aids 24-50
24.4.28 Osteogenic Stimulation 24-55
24.4.28.1 Noninvasive Electrical Osteogenic Stimulator 24-55
24.4.28.2 Invasive Electrical Osteogenic Stimulator 24-55
24.4.28.3 Ultrasound Osteogenic Stimulator 24-56
24.4.28.4 Professional Services 24-56
24.4.28.5 Prior Authorization 24-56
24.4.29 Respiratory Equipment and Supplies 24-56
24.4.29.3 Humidification Units 24-57
24.4.29.4 Secretion Clearance Devices 24-58
24.4.29.5 Electrical Percussor 24-58
24.4.29.6 Chest Physiotherapy Devices 24-58
24.4.29.7 Positive Airway Pressure System Devices 24-59
24.4.29.8 Continuous Positive Airway Pressure (CPAP) System 24-60
24.4.29.9 Bi-level Positive Airway Pressure System (BiPAP S) Without Backup 24-60
24.4.29.10 Bi-level Positive Airway Pressure System With Backup (BiPAP ST) 24-61
24.4.29.11 Home Mechanical Ventilation Equipment 24-61
24.4.29.12 Volume Ventilators 24-61
24.4.29.13 Negative Pressure Ventilators 24-62
24.4.29.14 Ventilator Service Agreement 24-62
24.4.29.15 Oxygen Therapy 24-62
24.4.29.16 Initial Oxygen Therapy Medical Necessity Certification 24-63
24.4.29.17 Oxygen Therapy Recertification 24-63
24.4.29.18 Oxygen Therapy Home Delivery System 24-63
24.4.29.19 Tracheostomy Tubes 24-64
24.4.29.20 Pulse Oximetry 24-64
24.4.29.21 Procedure Codes and Limitations for Respiratory
Equipment and Supplies 24-64
24.4.30 Procedure Codes That Do Not Require Prior Authorization 24-65
24.4.31 Nutritional (Enteral) Products, Supplies, and Equipment 24-66
24.4.31.1 Nutritional Products and Supplies 24-66
24.4.31.2 Enteral Nutritional Products 24-67
24.4.31.3 Enteral Feeding Pumps 24-67
24.4.32 Limitations, Exclusions 24-68
24.5 Medicaid Relationship to Medicare 24-69
24.5.1 Possible Medicare Clients 24-69
24.5.2 Benefits for Medicare/Medicaid Clients 24-69
24.5.3 Medicare and Medicaid Prior Authorization 24-70
24.6 Prohibition of Medicaid Payment to Home Health Agencies Based on Ownership 24-70
24.7 Claims Information 24-71
24.7.1 Benefit Code 24-71
24.7.2 National Drug Code (NDC) 24-71
24.8 Claim Filing Resources 24-72
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