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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 : Electrical Percussor
The electrical percussor device requires prior authorization. The electrical percussor may be prior authorized for rental or purchase depending on the physician’s predicted length of treatment.
In addition to the completed Title XIX order form, a description of all previous courses of therapy and why they did not adequately assist the client in airway mucus clearance is required to obtain authorization for an electrical percussor.

Texas Medicaid & Healthcare Partnership
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