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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.7 Orthotic and Prosthetic Services (CCP) : 2.7.6 Claims Information

Submit services provided by orthotic and prosthetic suppliers in an approved electronic format or on a CMS-1500 paper claim form. Providers must purchase CMS-1500 paper claim forms from the vendor of their choice. TMHP does not supply the forms.
Include the name of the referring physician in Block 17 of CMS-1500 paper claim form or its electronic equivalent. Orthotics or prosthetics may be billed in the office, home, or outpatient setting. Claims for services that have been prior authorized must reflect the PAN in Block 23 of the CMS-1500 paper claim form or its electronic equivalent.
Refer to:
Form CH.28, “Orthotic and Prosthetic Services (CCP Only)” in this handbook for a claim form example.

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