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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 : 9.2.56 Physician Evaluation and Management (E/M) Services : 9.2.56.2 Domiciliary, Rest Home, or Custodial Care Services

9.2.56.2
The following procedure codes are used to report E/M in a facility that provides room, board, and other personal assistance services:
 
 
Established patient visits billed on the same date of service as a new patient visit, by the same provider, will be denied as part of another procedure. Established patient visits are limited to one per day regardless of diagnosis.

Texas Medicaid & Healthcare Partnership
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