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December 2016 Texas Medicaid Provider Procedures Manual

Home Health Nursing and Private Duty Nursing Services Handbook : 6 Claims Filing and Reimbursement : 6.1 Claims Filing : 6.1.2 PDN Providers

6.1.2
Independently enrolled RNs or LVNs providing PDN services must submit claims on the HCFA-1500 claim form. PDN Providers who are home health agencies must submit claims on the HCFA-1450 (UB-92) claim form.
PDN providers must submit claims for services in an approved electronic claims format or on the appropriate claim form based on their provider type. Home health agencies must submit claims on the UB-04 CMS-1450 paper claim form. Independently enrolled nurses must submit claims on the CMS-1500 paper claim form.

Texas Medicaid & Healthcare Partnership
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