TMPPM 2008 > Texas Medicaid Services > Dental > Billing TMHP

19.23 Billing TMHP

The examining physician, anesthesiologist, hospital, ASC, or HASC must bill TMHP or the appropriate MCO separately for the medical and facility components of their services. The claim forms used are the CMS-1500 or the UB-04 CMS-1450:

•Type of service (TOS) 7, CPT code 00170 with modifier EP, is for the anesthesiologist or certified registered nurse anesthetist (CRNA) to use on the claim form.

•TOS F, CPT code 41899 with modifier EP, is for the facility to use on the claim form.

•Diagnosis codes, such as 52100 and 5220 are to be used on the claim form by both provider types.

•Modifier EP identifies that the service is associated with THSteps.

To satisfy the preadmission history and physical examination requirements of the hospital, ASC, or HASC, a THSteps medical check up for dental rehabilitation/restoration may be performed by the child's primary care provider. Physicians who are not enrolled as THSteps medical providers should bill for the examination of a client before the procedure with the appropriate evaluation and management code from the following table:

Providers enrolled in THSteps Medical should refer to "Exceptions to Periodicity" on page 43-9.

Note: The dental provider should bill TMHP using the ADA Dental Claim Form to be considered for reimbursement through THSteps Dental Services.

Refer to: The ADA website at www.ada.org/prof/resources/topics/claimform.asp for a sample of the ADA Dental Claim form.