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2012 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 8. Tuberculosis Services : 8.2 Services, Benefits, Limitations, and Prior Authorization : 8.2.1 TB-Related Clinic Services

8.2.1
The following services may be performed by a physician, APRN, or PA in the TB clinic:
A physician’s presence is not required to perform procedure code 99211; however, the physician must provide direct supervision by being present in the clinic and immediately available to furnish assistance and direction at the time service is provided.
Before TB treatment can be initiated, an initial screening (procedure code T1023) by an RN, LPN, or LVN, or a new patient physician E/M visit (procedure code 99201, 99202, 99203, 99204, or 99205) must be performed. If the treatment is initiated by a nursing screening, a new patient physician E/M visit must be completed within 90 days, or subsequent reimbursement for DOT (procedure code H0033) will be denied.
Following the initial new patient physician E/M visit, an established patient physician E/M visit (procedure code 99212, 99213, 99214, or 99215) must be billed every 90 days throughout the course of treatment, or subsequent reimbursement for DOT (procedure code H0033) will be denied.
Clients with latent TB infection, including those in a high-risk group (children who are 4 years of age and younger, those who are immunocompromised, and clients who are HIV-positive), and those with active TB disease, must be seen by a physician every 90 days throughout the course of treatment.
A physician must evaluate each client with active or latent TB disease prior to discharge from TB treatment.
Procedure codes H0033, T1002, T1003, and T1023 may be provided under established clinic protocols.
The initial TB screening (procedure code T1023), performed by an RN, LPN, or LVN includes, but is not limited to the following:
Procedure code T1023 may be reimbursed prior to the client being seen by a physician, and no more than once per 12 months. One RN or LVN/LPN (procedure codes T1023, T1002, and T1003) service may be reimbursed per day, per client, when physician services are not performed.
Subsequent nursing services (Procedure code T1002 and T1003) may be a benefit when not provided the same day as a physician evaluation and management (E/M) visit.
Reimbursement for DOT services (procedure code H0033) provided in the clinic or other places of service, excluding inpatient hospitals, skilled nursing facilities, intermediate care facilities, outpatient hospitals, independent laboratories, birthing centers, and extended care facilities will be limited to one per day, and a maximum of five per week, per client, throughout the course of treatment.
Procedure codes T1002 and T1003 are limited to a maximum of eight 15-minute units per day, per client.
If the total number of minutes of nursing services per procedure code is less than eight minutes for a calendar day, then no unit of service can be billed for that day. The minutes cannot be added to minutes of nursing services from any previous or subsequent days for billing purposes.
If more than one unit of service is billed, every unit except the last must be for the complete 15 minutes, with the last unit being no less than eight minutes of nursing service.
Reimbursement for new client examinations (procedure code 99201, 99202, 99203, 99204, and 99205) are limited to new clients who have not received services in the same clinic for a period of three years.
One physician E/M service may be reimbursed per day, per client.
In the following table, the procedure codes in Column A will be denied when billed for the same date of service as the corresponding procedure codes in Column B:

Texas Medicaid & Healthcare Partnership
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