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2012 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 8. Physician : 8.2 Services, Benefits, Limitations, and Prior Authorization : 8.2.69 Skin Therapy

8.2.69
Skin therapy is a benefit of Texas Medicaid and may be reimbursed with the following procedure codes:
Claims for incision and drainage of acne when the diagnosis states there is infection or pustules may be paid.
Procedure codes 96900, 96910, 96912, 96913, 96920, 96921, and 96922 are covered benefits for the following diagnosis codes:
Procedure codes 96910 and 96912 will be denied when billed with procedure code 96913.
If billed with an office visit, an emergency room visit, or consult, procedure code 96900, 96910, or 96912 will be denied as part of the visit or consult.
If procedure code 96913 is billed with an office visit, emergency room visit or consult, the visit will be denied as part of the treatment.
Intralesional injection(s) may be considered for reimbursement in addition to an office visit.
Procedure codes 11900 and 11901 are covered benefits for intralesional injections for the following diagnosis codes:
Procedure codes 15782, 15783, 15792, 15793, and 17999 require prior authorization. Requests for prior authorization must be submitted by the physician to the Special Medical Prior Authorization (SMPA) department with documentation supporting the medical necessity of the anticipated procedure. This documentation must remain in the client’s medical record and is subject to retrospective review. To avoid unnecessary denials, the physician must provide correct and complete information.
Dermabrasion procedures (procedure codes 15782 and 15783) and chemical peel procedures (procedure codes 15792 and 15793) may be prior authorized with documentation that the client meets all of the following criteria:
Prior authorization requests for procedure code 17999 must include the following documentation:

Texas Medicaid & Healthcare Partnership
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