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December 2016 Texas Medicaid Provider Procedures Manual

Certified Respiratory Care Practitioner (CRCP) Services Handbook : 4 CRCP-CCP Services : 4.1 Services, Benefits, Limitations, and Prior Authorization

4.1
In-home respiratory services by a licensed certified respiratory care practitioner are a benefit of the Texas Medicaid Comprehensive Care Program (CCP) for non-ventilator dependent clients who are birth through 20 years of age when rendered by providers who are enrolled with Texas Medicaid as follows:
CRCP services are a benefit when provided in the home setting for a client with a chronic underlying respiratory illness, or a newly diagnosed long-term respiratory condition that is currently resulting in a suboptimal respiratory status.
The services provided through this policy are designed to maximize the client or caregiver’s ability to self-manage the client’s disease when the physician deems the client or caregiver will benefit from the expertise of a respiratory care practitioner for the provision of respiratory care or education. Respiratory therapy care services that do not require the specialty of a certified respiratory care practitioner are not a benefit. The certified respiratory care practitioner’s services allow for the performance of pulmonary care, when required, and the education of the client or caregivers in:
Refer to:
Section 3, “CRCP Services” in this handbook for respiratory care practitioner services for clients who are ventilator-dependent.
Providers must use the following procedure codes for in-home respiratory services:
 
A certified respiratory care practitioner must hold a certificate or temporary permit in compliance with the Texas Occupations Code, Chapter 604, Subchapter A.
A certified respiratory care practitioner must meet the following requirements:
Be enrolled and approved for participation with Texas Medicaid as an independent practitioner or be employed by a physician, physicians group, or home health agency.
Procedure codes S9441, 98960, and 99503 are each limited to once per day, by any provider, and twice per lifetime. Additional visits may be reimbursed when additional prior authorization criteria have been met.
Providers will not be reimbursed for procedure codes S9441, 98960, 99503, or 99504, in any combination, if submitted on the same date of service, by 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. Retrospective review may be performed to ensure documentation supports the medical necessity of the service when claims are submitted for the procedure codes listed within this handbook.

Texas Medicaid & Healthcare Partnership
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