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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 : 2.2.19 Respiratory Equipment and Supplies : 2.2.19.5 Secretion Clearance Devices

2.2.19.5
Secretion Clearance Devices
2.2.19.5.1 Incentive Spirometer
Incentive spirometers, including electronic spirometers, are a benefit of Home Health Services.
2.2.19.5.2 Intermittent Positive-Pressure Breathing (IPPB) Devices
Rental of the IPPB device includes all supplies, such as humidification and tubing.
Purchase of the IPPB device is not a benefit.
2.2.19.5.3 Mucous Clearance Valve
Providers must use procedure code S8185 when billing for the purchase of a mucous clearance valve.
The mucous clearance valve may be reimbursed for the following diagnosis codes only:
Other diagnoses may be considered based on review of documentation by HHSC or its designee. Hypertonic saline 7 percent for inhalation therapy is a benefit of Texas Medicaid for clients with a diagnosis of cystic fibrosis. Hypertonic saline 7 percent for inhalation therapy may be billed using procedure code T1999 and requires prior authorization. To request prior authorization, providers must submit either the MSRP, the provider’s invoice cost, or the AWP. Providers may be reimbursed 82 percent of the MSRP or 85 percent of the AWP per ampoule or the provider’s invoice cost if the MSRP is not available.
2.2.19.5.4 Prior Authorization
IPPB Devices
The rental of IPPB, procedure code E0500, requires prior authorization and may be given with documentation of ineffective response with other modalities such as treatment with a cough assist device for four months or longer.
The IPPB device may be prior authorized for the following diagnoses:
Other diagnoses may be considered based on review of documentation by HHSC or its designee.
Mucous Clearance Valve
The mucous clearance valve requires prior authorization and may be reimbursed for purchase only, and that purchase is limited to one every five years.

Texas Medicaid & Healthcare Partnership
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