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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 4. Department of State Health Services (DSHS) Family Planning Program Services : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.10 Reimbursement for WHP Wrap-Around Services

4.2.10
FQHC providers may receive DSHS Family Planning Program reimbursement for WHP wrap-around services that are rendered during a visit where the primary purpose of the visit is not related to contraception and is not reimbursed by WHP.
FQHC providers may receive reimbursement for the following services that are rendered to WHP clients when the primary diagnosis is not related to contraception:
Follow-up Pap tests. To receive reimbursement, DSHS contractors must file a separate claim with diagnosis code 6229. DSHS contractors may be reimbursed for the Pap test, an appropriate counseling code, and the appropriate visit code.
Follow-up visits for STD/STI testing. To receive reimbursement for a visit that is strictly for the purposes of STD/STEI testing for a WHP client, DSHS contractors must file a separate claim with a diagnosis code of V016. DSHS contractors may be reimbursed for STD/STI tests and STD/STI-related services.
Pregnancy-test-only visits. To receive reimbursement for a visit that is for a pregnancy test only, DSHS contractors must file a separate claim with diagnosis code V7240.
Claims that are submitted by FQHC providers for wrap-around services, but are considered part of a WHP encounter, will be subject to retrospective review as these claims are not eligible for reimbursement. Any wrap-around services that are determined to have been paid in error may be recouped.

Texas Medicaid & Healthcare Partnership
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