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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) : 2.4.16 Vitamin and Mineral Products

2.4.16
2.4.16.1
Vitamin and mineral products prescribed or ordered by a physician to treat various conditions are a benefit of Texas Medicaid through the Comprehensive Care Program (CCP) for clients who are 20 years of age and younger.
Vitamin and mineral products must be submitted with procedure code A9152 or A9153, the appropriate modifier, and the corresponding National Drug Code. Units must be based on the quantity dispensed, for up to a 30-day supply.
For purposes of billing, one unit is equal to one dose. The total billable units are equal to the total doses requested on the prior authorization.
Providers must dispense the most cost-effective product prescribed in accordance with a prescription from a licensed physician. Organic products will not be reimbursed unless medical documentation is provided to substantiate the need for that formulation.
The following vitamin and mineral products may be a benefit when submitted with the corresponding procedure code and state-identified modifier:
Vitamin B6 (pyridoxine, pyridoxal 5-phosphate)
Note:
Vitamin and mineral products may be indicated for, but are not limited to, treatment of the following conditions:
Vitamin B6 (pyridoxine, pyridoxal 5-phosphate)
Disturbances of sulphur-bearing amino-acid metabolism (e.g., homocystinuria and disturbances of metabolism of methionine)

Texas Medicaid & Healthcare Partnership
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