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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 : 9.2.76 Wearable Cardiac Defibrillator (WCD)

9.2.76
A WCD (procedure codes 93292, 93745, and K0606) are a benefit of Texas Medicaid.
The rental of a WCD (procedure code K0606) is limited to once per month and must be submitted with modifier RR.
Modifier 25 may be used to identify a significant separately identifiable evaluation and management service performed (for example, different diagnosis) on the same day as the initial set up of a WCD by the same provider for the same client. Documentation that supports the provision of a significant, separately identifiable E/M service must be maintained in the client’s medical record and made available to Texas Medicaid upon request.
Procedure code 93292 will be denied as part of procedure code 93745 when submitted on the same date of service by any provider.
Procedure codes 93000, 93005, 93010, 93040, 93041, and 93042 will be denied as part of procedure code 93745 when submitted on the same date of service by any provider.

Texas Medicaid & Healthcare Partnership
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