Table of Contents Previous Next Index

2012 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2. Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.16 Osteogenic Stimulation : 2.2.16.4 Documentation Requirements

2.2.16.4
A summary of the radiology reports and the date the fracture occurred must be submitted with the prior authorization request for any osteogenic stimulator. The manufacturer will replace the osteogenic stimulator during the course of treatment should the device become nonfunctional. Repairs to purchased equipment will not be prior authorized. All repairs are considered part of the purchase price. Osteogenic stimulators may be replaced during the course of treatment if the device becomes nonfunctional. Repairs to purchased equipment are not prior authorized. All repairs are considered part of the purchase price. A new osteogenic stimulator may be considered for prior authorization with documentation supporting treatment of a different fracture site.
Documentation supporting medical necessity for an osteogenic stimulator is subject to retrospective review. Osteogenic stimulators that do not meet the criteria for coverage through Texas Medicaid (Title XIX) Home Health Services may be considered through CCP for clients who are 20 years of age and younger.

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