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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 : 9.2.28 Evoked Response Tests and Neuromuscular Procedures : 9.2.28.4 Motion Analysis Studies

9.2.28.4
Motion analysis studies (procedure codes 96000, 96001, 96002, and 96003) are a benefit of Texas Medicaid for clients who are 3 through 20 years of age.
Procedure codes 96000, 96001, 96002, and 96003 are limited to one per date of service by the same provider and two per rolling year, any provider.
In the following table, the procedure codes in Column A will be denied when they are submitted on the same date of service by the same provider as the procedure codes in Column B:
 
Documentation must include the following information that indicates the client meets all the requirements for motion analysis studies. The client must be:
The reason for the referral and a clear diagnostic impression must be documented in the client’s medical record for each motion analysis study performed.
The client’s medical records must clearly document the medical necessity for the motion analysis study. The medical record documentation must reflect the actual results of specific tests.
Medical necessity for re-evaluation of a client (beyond the initial consultation and testing) must be clearly documented in the client’s medical record. Supporting documentation includes, but is not limited to, the following:
The client’s medical records are subject to retrospective review.

Texas Medicaid & Healthcare Partnership
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