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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.4 Durable Medical Equipment (DME) Supplier (CCP) : 2.4.9 Incontinence Supplies : 2.4.9.2 Prior Authorization and Documentation Requirements

2.4.9.2
Prior authorization is required for incontinence supplies through CCP.
A determination is made by HHSC or its designee as to the number of incontinence supplies prior authorized based on the client’s medical needs.
Additional quantities may be considered with documentation of medical necessity.
The quantity of incontinence supplies billed for a one-month period must be consistent with the number of times per day the physician has ordered the supply be used on the CCP Prior Authorization Request Form.
To request prior authorization for incontinence supplies, the following documentation must be provided for the item(s) requested:
Accurate diagnostic information pertaining to the underlying diagnosis/condition as well as any other medical diagnoses/conditions, to include the client’s overall health status
Additional information may be requested to clarify or complete a request for the supplies and equipment.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.