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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 : 2.2.25 Procedure Codes That Do Not Require Prior Authorization

2.2.25
The procedure codes listed in the following table do not require prior authorization for clients who are receiving services under Home Health Services. Although prior authorization is not required, providers must retain a completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form for these clients. For medical supplies not requiring prior authorization, a completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form may be valid for a maximum of six months unless the physician indicates the duration of need is less. If the physician indicates the duration of need is less than six months, then a new Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form is required at the end of the duration of need. It is expected that reasonable, medically necessary amounts will be provided.
The use of these services is subject to retrospective review. This is not an all inclusive list.
 
* Prior authorization is required for certain diagnoses and if limitations are exceeded. Refer to Subsection 2.2.19.2, “Nebulizers” in this handbook.
** Prior authorization is required for some procedure codes if the maximum limitation is exceeded. Refer to Subsection 2.2.13.9, “Incontinence Procedure Codes with Limitations” in this handbook.

Texas Medicaid & Healthcare Partnership
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