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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 : 9.2.43 Neurostimulators : 9.2.43.14 Prior Authorization of Neurostimulator Devices Procedure Codes

9.2.43.14
The following device procedure codes may be reimbursed with prior authorization:
 
To identify the service as a VNS device, procedure code L8686 must be submitted with modifier TG. Only one similar device code may be reimbursed per date of service for any provider.

Texas Medicaid & Healthcare Partnership
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