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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.14 Bone Growth Stimulation

Professional services for bone growth stimulation (procedure codes 20974, 20975, and 20979) are a benefit of Texas Medicaid
Prior authorization is required for a bone growth stimulator device (procedure codes E0747, E0748, E0749, and E0760).
Refer to:
Subsection 2.2.7, “Bone Growth Stimulators,” in the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook (Vol. 2, Provider Handbooks) for prior authorization criteria.

Texas Medicaid & Healthcare Partnership
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