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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 : 2.2.22 Total Parenteral Nutrition (TPN) Solutions

In-home TPN is a benefit for eligible clients who require long-term nutritional support. “Long-term nutritional support” refers to treatment lasting 30 days or longer.
Conditions that may require TPN include, but are not limited to the following:
TPN services are not a benefit when oral or enteral intake will maintain adequate nutrition.
Parenteral nutrition solution services may be reimbursed using the following procedure codes:
Parenteral nutrition supplies may be reimbursed using the following procedure codes: B4220, B4222, B4224, and B9999.
Parenteral nutrition infusion pumps may be reimbursed using procedure codes B9004 and B9006.
A backpack or carrying case for a portable parenteral nutrition infusion pump may be a benefit of Home Health Services, when medically necessary and prior authorized, using procedure code B9999.
In-home TPN for clients who are 20 years of age and younger that do not meet the criteria through Title XIX Home Health Services may be considered through CCP. No more than a one-week supply of solutions and additives may be reimbursed if the solutions and additives are shipped and not used because of the client’s loss of eligibility, change in treatment, or inpatient hospitalization. Any days that the client is an inpatient in a hospital or other medical facility or institution must be excluded from the daily billing. Payment for partial months will be prorated based upon the actual days of administration.
The administration of intravenous fluids and electrolytes cannot be billed as in-home TPN.
Claims for TPN must contain the 9-character prior authorization number in Block 23. Providers must consult with their vendor for the location of this field in the electronic claims format. The prescribing physician name and provider identifier must be in Block 17 and 17a or in the appropriate field of the provider’s electronic software.

Texas Medicaid & Healthcare Partnership
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