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December 2016 Texas Medicaid Provider Procedures Manual

Women’s Health Services Handbook : 2 Healthy Texas Women (HTW) Program Overview : 2.3 * Services, Benefits, Limitations, and Prior Authorization : 2.3.2 Family Planning Annual Exams

2.3.2
Family planning providers must bill one of the following E/M visit procedure code based on the complexity of the annual family planning examination provided:
 
The following table summarizes the uses for the E/M procedure codes and the corresponding billing requirements for the annual examination:
 
One new patient E/M code every 3 years following the last E/M visit provided to the client by that provider or a provider of the same specialty in the same group

Texas Medicaid & Healthcare Partnership
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