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December 2016 Texas Medicaid Provider Procedures Manual

Certified Respiratory Care Practitioner (CRCP) Services Handbook : 3 CRCP Services : 3.1 Services, Benefits, Limitations, and Prior Authorization

Certified respiratory care practitioner services are a benefit of Texas Medicaid when provided in the home setting for ventilator-dependent clients by providers enrolled in Texas Medicaid as respiratory therapists.
Subject to the following specifications, conditions, and limitations, in-home certified respiratory care practitioner services are available to eligible clients who:
Have been ventilator-dependent for at least 30 consecutive days as an inpatient in one or more hospitals, skilled nursing facilities (SNF), or intermediate care facilities (ICF).
Require professional respiratory therapy services in addition to those respiratory therapy services that are provided through the Home Health durable medical equipment (DME) lease of a ventilator, or the respiratory therapy monthly visit covered through the Home Health Ventilator Service Agreement when the ventilator is client-owned.
For clients who are birth through 20 years of age who do not meet the criteria above, services to be performed by a certified respiratory care practitioner may be considered through the Comprehensive Care Program (CCP).
Benefits include, but are not necessarily limited to, the following:
Respiratory therapy services and treatments prescribed by a physician who is familiar with the client’s medical history and care, and who has medically determined that in-home care is safe and feasible for the client.
Education of the client, the appropriate family members, or support persons regarding the in-home respiratory care. Education must include the use and maintenance of required supplies, equipment, and techniques appropriate to the situation.
Providers must use procedure code 99504 for in-home respiratory services.
Providers of respiratory therapy services must meet the following requirements:
Sign a written provider agreement with the Health and Human Services Commission (HHSC) or its designee. By signing the agreement, the provider agrees to comply with the terms of the agreement and all requirements of the Texas Medical Assistance Program including regulations, rules, handbooks, standards, and guidelines published by HHSC or its designee.
The professional service may be billed by the certified respiratory care practitioner for services provided in the client’s home (procedure code 99504). The professional service will be allowed once per day up to a limit of 24 visits per year. The recommended schedule includes 7 visits during the first week, a total of 6 visits during the second through fourth week, and 11 monthly visits for the second through the 12th month.
Providers will not be reimbursed for procedure codes 99503 and 99504 on the same date of service, any provider.
Disposable respiratory supplies are a benefit through Texas Medicaid Title XIX Home Health Services and are not reimbursed to the certified respiratory therapist.

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