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December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 3 Case Management for Children and Pregnant Women : 3.3 Services, Benefits, Limitations, and Prior Authorization

3.3
Case Management for Children and Pregnant Women services are limited to one contact per day per client. Additional provider contacts on the same day are denied as part of another service rendered on the same day.
Procedure code G9012 is to be used for all Case Management for Children and Pregnant Women services. Modifiers are used to identify which service component is provided.
 
G9012 with modifier U5 and modifier U2
G9012 with modifier U5 and modifier TS
G9012 with modifier TS
Providers must adhere to Case Management for Children and Pregnant Women program rules, policies, and procedures.
Note:
Case Management for Children and Pregnant Women providers are not required to file claims with other health insurance before filing with Medicaid.
Reminder:
Case Management for Children and Pregnant Women services are not billable when a client is an inpatient at a hospital or other treatment facility.
Reimbursement will be denied for services rendered by providers who have not been approved by the DSHS Health Screening and Case Management Unit.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.