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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 : 2.2.16 Nutritional (Enteral) Products, Supplies, and Equipment : Enteral Nutritional Products, Feeding Pumps, and Feeding Supplies
Enteral nutritional products and related feeding supplies and equipment are a benefit through Home Health Services for clients who are 21 years of age and older and require tube feeding as their primary source of nutrition. The enteral product, supply, or equipment must be part of the medical POC outlined and maintained by the treating physician.
Enteral nutritional products may be reimbursed with the following procedure codes:
Enteral nutritional supplies and equipment may be reimbursed with the following procedure codes and limitations:
As needed*
If procedure code T1999 is used for a needleless syringe, the allowed amount is 8 per month.
* Appropriate limitations for miscellaneous procedure codes B9998 and T1999 are determined on a case-by-case basis through prior authorization. Specific items may be requested using procedure code B9998 using the modifiers outlined in the table above.
A backpack or carrying case for a portable enteral nutrition infusion pump may be a benefit of Home Health Services, when medically necessary and prior authorized, using procedure code B9998.

Texas Medicaid & Healthcare Partnership
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