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December 2016 Texas Medicaid Provider Procedures Manual

Home Health Nursing and Private Duty Nursing Services Handbook : 3 Home Health Skilled Nursing and Home Health Aide Services : 3.4 * Authorization Requirements : 3.4.2 * Home Health Services Plan of Care Requirements : 3.4.2.2 DME and Medical Supplies Submitted with a Plan of Care (POC)

3.4.2.2
The cost of incidental medical supplies used during an SN or HHA visit may be added to the charge of the visit ($10 maximum for medical supplies and included in G0299 or G0300 visit code). Medical supplies left at the home for the client to use must be billed with the provider identifier enrolled as a DME supplier after prior authorization has been granted by the TMHP Home Health Services Prior Authorization Department.
Refer to:
Subsection 2.2, “Services, Benefits, Limitations and Prior Authorization” in the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook (Vol. 2, Provider Handbooks) for information about DME and medical supplies prior authorization.
When the home health services POC is used to submit a prior authorization for DME or medical supplies that will be used in conjunction with the professional services provided by the agency, such as SN, HHA, OT, or PT, the home health agency’s DME provider identifier must be submitted on the POC, and all of the requested DME and medical supplies must be listed in the “Supplies" section of the POC.
The POC does not require a physician’s signature before prior authorization of professional services, DME, or medical supplies is requested but does require the assessing RNs dated signature. The POC must be signed and dated by a primary physician familiar with the client prior to submitting a claim for services and no later than 30 days from the SOC date.
If the home health agency uses the Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form, the agency must complete Section A. A primary physician familiar with the client must complete, sign, and date Section B prior to submission to TMHP for prior authorization of the requested DME or medical supplies.
The following information is required to consider these medical supplies for prior authorization:
Refer to:
Subsection 2.2, “Services, Benefits, Limitations and Prior Authorization” in the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook (Vol. 2, Provider Handbooks) for information about DME and medical supplies prior authorization.

Texas Medicaid & Healthcare Partnership
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