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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 : 2.2.19 Respiratory Equipment and Supplies : 2.2.19.1 Prior Authorization

2.2.19.1
Most respiratory equipment and supplies, with the exception of the codes noted below, require prior authorization.
The following procedure codes do not require prior authorization:
 
Prior authorization is required for rental or purchase of respiratory equipment and supplies not listed above provided through the Texas Medicaid Title XIX Home Health Services. To complete the prior authorization process, the provider should submit the completed Title XIX Form to the Home Health Unit.
A completed Title XIX Home Health Durable Medical Equipment (DME)/Medical Supplies Physician Order Form prescribing the DME or medical supplies must be signed and dated by the prescribing physician familiar with the client prior to requesting authorization. The completed Title XIX Form must be maintained by the requesting provider and the prescribing physician. The original signature copy must be kept in the physician’s medical record for the client.
In addition to the Texas Medicaid Title XIX Home Health Durable Medical Equipment (DME)/Medical Supplies Physician Order Form, all other required forms must be signed and dated by the prescribing physician who is familiar with the client before requesting authorization.
Requests for prior authorization or recertification must include documentation by the physician who is familiar with the client that the client is compliant with the use of the equipment and that the treatment is effective.
To avoid unnecessary denials, when requesting prior authorization for respiratory equipment and supplies, the physician must provide correct and complete information, supporting the medical necessity of the equipment or supplies requested, including:
The provider may be asked to provide additional information to clarify or complete a request for respiratory supplies or accessories.
The following includes, but is not limited to, respiratory equipment that require prior authorization:

Texas Medicaid & Healthcare Partnership
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