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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2 Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.7 Early Childhood Intervention (ECI) Services : 2.7.2 * Services, Benefits, Limitations, and Prior Authorization : 2.7.2.4 Targeted Case Management (TCM)

2.7.2.4
Targeted Case Management (TCM) services are provided to help eligible clients gain access to needed medical, social, educational, developmental, and other appropriate services.
Providers may perform and submit claims for TCM services after the client’s ECI eligibility has been established. The IFSP does not have to be completed before providers may perform TCM services and submit claims to Texas Medicaid.
DARS provides additional guidance to ECI contractors about requirements for including ongoing case management services on the IFSP.
Providers must use procedure code T1017 when billing for TCM services, which are billed in 15-minute increments.
TCM services may be delivered face-to-face or by telephone. Providers must use procedure code T1017 for telephone interaction and T1017 with modifier U1 for face-to-face interaction. The POS is determined by the service coordinator’s location at the time the service is rendered.
Claims may be submitted to Texas Medicaid when the interaction is with the client or the client’s parent(s) (as defined in 10 United States Code (U.S.C.) §1401) or other routine caregiver(s), or occurs in the presence of the client or the client’s parent(s) or other routine caregiver.
Providers may contact other individuals to help eligible clients gain access to needed medical, social, educational, developmental, and other appropriate services, to help identify the eligible client’s needs, to assist the eligible client in obtaining services and to receive useful feedback and alert the service coordinator to changes in the eligible client’s needs. These contacts must be documented in the client’s record, but claims may not be submitted to Texas Medicaid for reimbursement unless the contacts occur in the presence of the client and the client’s parent(s) or other routine caregiver.
TCM must be provided as stated in 40 TAC, Part 2, Chapter 108, Subchapter D.
All documentation must be retained in the client’s record and available upon request. The documentation must be in compliance with 40 TAC, Part 2, Chapter 108, Subchapter D, §108.415.
TCM services are provided by an ECI provider. The ECI provider ensures that TCM services are provided by a service coordinator who meets the criteria established in 40 TAC Part 2, Chapter 108, Subchapter C, §108.315.

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