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December 2016 Texas Medicaid Provider Procedures Manual

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook : 3 Obstetric Services : 3.1 *Services, Benefits, Limitations, and Prior Authorization : 3.1.2 Vaginal and Cesarean Deliveries : Home Deliveries
Home deliveries and the home supplies for the delivery (S8415) require submitting a written prior authorization request during the client’s third trimester of pregnancy. Home deliveries will not be prior authorized to a licensed midwife.
Documentation must include:
A statement signed by a licensed physician who examined the client during the third trimester and determined at the time of examination the client is not at high risk for complications and is suitable for a home delivery

Texas Medicaid & Healthcare Partnership
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