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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) : 2.4.11 Nutritional Products

2.4.11
2.4.11.1
Medical nutritional products including enteral formulas and food thickener, may be approved for clients who are CCP-eligible, birth through 20 years of age, and have specialized nutritional requirements. Medical nutritional products must be prescribed by a physician and be medically necessary.
Nutritional products may be reimbursed with the following procedure codes:
Enteral nutrition supplies and equipment may be reimbursed with the following procedure codes and limitations:
* Appropriate limitations for miscellaneous procedure codes B9998 and T1999 are determined on a case-by-case basis through prior authorization. Specific items may be requested using procedure code B9998 and the modifiers outlined in the table above.
The purchase of a backpack or carrying case for a portable enteral feeding pump may be a benefit of CCP, using procedure code B9998, if it is medically necessary and prior-authorized.
Clients for whom nutritional products are being requested may benefit from nutritional counseling. Nutritional counseling is a benefit of CCP if it is provided to treat, prevent, or minimize the effects of illness, injury, or other impairment.
Refer to:
Subsection 2.6, “Medical Nutrition Counseling Services (CCP)” in this handbook for information about nutritional counseling.

Texas Medicaid & Healthcare Partnership
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