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2012 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 5. Ambulatory Surgical Center and Hospital Ambulatory Surgical Center : 5.2 Services/Benefits, Limitations, and Prior Authorization : 5.2.9 Implantable Infusion Pumps : 5.2.9.1 Prior Authorization for Implantable Infusion Pump

5.2.9.1
Providers must request prior authorization for the implantable infusion pump through the SMPA department with the supporting documentation for medical necessity. Send authorization requests to:
Texas Medicaid & Healthcare Partnership
Special Medical Prior Authorization
12357-B Riata Trace Parkway
Austin, TX 78727
Fax: (512) 514-4213
Requests for prior authorization can be submitted online through the TMHP website at www.tmhp.com.
Refer to:
Subsection 8.2.39.22.1, “Prior Authorization for Implantable Infusion Pumps,” in Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2 Provider Handbooks).

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