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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2 Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.6 Durable Medical Equipment (DME) Supplier (CCP) : 2.6.15 Total Parenteral Nutrition (TPN)

2.6.15
2.6.15.1
In-home TPN is a benefit of CCP for clients who require short-term or long-term nutritional support. Covered services must be medically necessary and prescribed by the physician.
Parenteral nutrition solution, supplies, and infusion pumps services may be reimbursed with the following procedure codes:
 
If the solutions and additives are shipped and not used because of the client’s loss of eligibility, change in treatment, or inpatient hospitalization, then no more than a one-week supply of solutions and additives will be reimbursed. Any days on which the client is an inpatient of a hospital or other medical facility or institution will be excluded from the daily billing. Payment for partial months will be prorated based upon the actual days of administration. The administration of intravenous fluids and electrolytes cannot be billed as in-home TPN.
A backpack or carrying case for a portable infusion pump may be a benefit when it is medically necessary and must be billed using procedure code B9999.
The infusion pump may be rented once a month or purchased once every five years.

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