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December 2016 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2 Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.5 Bath and Bathroom Equipment : 2.2.5.2 Bath Equipment

2.2.5.2
2.2.5.2.1
A bath or shower chair is a stationary or mobile seat with or without upper body or head support used to support a client who is unable to stand or sit independently in the shower or tub.
Bath/shower chairs are grouped into three levels of design to assist the client based on their physical condition and mobility status:
A tub stool or bench is a stationary seat or bench used to support a client who is unable to stand or sit independently in the shower or tub.
A tub transfer bench is a stationary bench that sits in the tub and extends outside the tub. It is used to support a client who is unable to stand or sit independently in the shower or tub and allows the client to scoot or slide over the side of the tub.
Bath or shower chairs, tub stools or benches, and tub transfers are limited to one every five years.
A custom bath or shower chair may be considered for prior authorization only if the client does not also have any type of commode chair.
Level 1 Group
A Level 1 device may be considered if the client:
Providers must use procedure code E0240 without a modifier when billing for Level 1 group bath or shower chairs.
Level 2 Group
A Level 2 device may be considered if the client:
The client must have a shower that is adapted for rolling equipment; ramps will not be prior authorized for access to showers.
Providers must use procedure code E0240 and modifier TF (Intermediate Level) when billing for Level 2 group bath or shower chairs.
Level 3 Group
A Level 3 device may be considered if the client requires:
Providers must use procedure code E0240 and modifier TG (Complex/high Level) when billing for Level 3 group bath/shower chairs.
A bath or shower chair may be prior authorized for clients who meet the Level 1, 2, or 3 criteria. A Level 3 custom bath or shower chair may be prior authorized only if the client does not also have any type of commode chair. A Level 3 mobile bath or shower chair may be considered for clients who have a shower that is adapted for rolling equipment; ramps will not be prior authorized for access to showers.
A tub stool or bench may be prior authorized for clients who meet the Level 1 criteria. Providers must use procedure code E0245 when billing for a tub stool or bench.
A tub transfer bench may be considered for clients who meet the Level 1 or 2 criteria. Providers must use procedure code E0247 when billing for a tub transfer bench.
A heavy duty tub transfer bench may be considered for clients who meet the Level 1 or 2 criteria and who weigh more than 200 pounds. Providers must use procedure code E0248 when billing for a heavy duty tub transfer bench.

Texas Medicaid & Healthcare Partnership
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