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 CSHCN Services Program Provider Manual - Release Notes 2016

The following table shows the chapters that were changed in the CSHCN Services Program Provider Manual in 2016. The changes are listed in reverse chronological order (newest first). The comments section provides links to previously published provider notifications, when available, that describe the changes.

2015 Release Notes

Reminder: Electronic Data Interchange Batch Identification Number to Change, Effective September 30, 2016

Information posted on September 7, 2016

Updated the holiday calendar in subsection 5.1.8, “Claims Filing Deadlines.”

Date

Section

Comments and Links to Related Articles

2016 November 30 Chapter 1:TMHP and DSHS Contact Information Updated contact information in subsection 1.3.2, “Regional Offices”.
2016 November 30Chapter 2: Provider Enrollment and Responsibilities Added CSCHN Services Program contact information for enrollment questions in subsection 2.1, “Provider Enrollment”.
2016 November 30Chapter 3: Client Benefits and Eligibility Corrected “Synctial” to “Syncytial” in subsection 3.1.2, “Respiratory Syncytial Virus (RSV) Prophylaxis”.
2016 November 30Chapter 16: Diagnostic Radiology Services Procedure Code 78816 to Become a Benefit for Positron Emission Tomography (PET) for the CSHCN Services Program

Information posted November 1, 2016
2016 November 30 Chapter 17: Durable Medical Equipment (DME) Corrected the TMHP-CSHCN Services Program contact center phone number in subsection 17.8, “TMHP-CSHCN Services Program Contact Center”.
2016 November 30 Chapter 31: Physician Corrected “Synctial” to “Syncytial” in subsection 3.1.2, “Respiratory Syncytial Virus (RSV) Prophylaxis”. Replaced form link in Section 31.2.24.15, “Respiratory Syncytial Virus (RSV) Prophylaxis.” Form link to CSHCN Synagis Request Form - http://www.txvendordrug.com/pa/rsv/2016/cshcn-synagis-pa-form.pdf.

Mepolizumab and Omalizumab Benefits to Change for the CSHCN Services Program on November 1, 2016

Information posted October 7, 2016
2016 October 31 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement   Added clarification to subsection 5.1.8, “Claims Filing Deadlines” regarding electronic claims that do not appear on the weekly R&S Report.
2016 October 31 Chapter 11: Blood Pressure Devices and Supplies

2017 ICD-10 Special Bulletin No. 10

Information posted September 30, 2016

2016 October 31 Chapter 14: Dental

Benefits for Preventive Dental Services to Change for the CSHCN Services Program

Information posted September 2, 2016

2016 October 31 Chapter 15: Diabetic Equipment and Supplies

2017 ICD-10 Special Bulletin No. 10

Information posted September 30, 2016

2016 October 31 Chapter 18: Expendable Medical Supplies

2017 ICD-10 Special Bulletin No. 10

Information posted September 30, 2016

2016 October 31 Chapter 20: Hearing Services

2017 ICD-10 Special Bulletin No. 10

Information posted September 30, 2016

2016 October 31 Chapter 25: Laboratory Services

2017 ICD-10 Special Bulletin No. 10

Information posted September 30, 2016

2016 October 31 Chapter 27: Neurostimulators and Neuromuscular Stimulators

2017 ICD-10 Special Bulletin No. 10

Information posted September 30, 2016

2016 October 31 Chapter 30: Physical Medicine and Rehabilitation

Therapy Treatment Procedure Codes 97034, 97035, and 97036 Subject to NCCI Guidelines

Information posted August 31, 2016

2016 October 31 Chapter 31: Physician

2017 ICD-10 Special Bulletin No. 10

Information posted September 30, 2016

Benefit Changes for Botulinum Toxin Type A and Type B for the CSHCN Services Program, Effective October 1, 2016

Information posted October 4, 2016

2016 October 31 Chapter 39: Vision Services

2017 ICD-10 Special Bulletin No. 10

Information posted September 30, 2016

2016 September 30 Chapter 31: Physician Revised diagnosis descriptions for codes M5001, M5011, M5021, M5031, M5081, and M5091 in Section 31.2.19.2, “Electromyography and Nerve Conduction Studies.”
2016 August 31 Chapter 3: Client Benefits and Eligibility Replaced mental retardation text with intellectual or developmental disability (IDD) text.
2016 August 31 Chapter 4: Prior Authorizations and Authorizations Correction to ‘Update to Prior Authorization Requirements for CSHCN Services Program Emergency Hospital Admissions’

Information posted July 15, 2016
2016 August 31 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement   Added clarification to subsection 5.1.8, “Claims Filing Deadlines” regarding electronic claims that do not appear on the weekly R&S Report.
2016 August 31 Chapter 14: Dental Update to CSHCN Services Program Provider Manual for Radiograph Procedure Code D0210
Information posted July 29, 2016

Unlisted Dentoalveolar Procedure Code 41899 to Require Prior Authorization for the CSHCN Services Program
Information posted July 27, 2016
2016 August 31 Chapter 16: Diagnostic Radiology Services Added clarification to subsection 16.2.7.1, “MRI Authorization Requirements” that four MRI procedures per rolling year do not require an authorization.
2016 August 31 Chapter 17: Durable Medical Equipment (DME) Replaced mental retardation text with intellectual or developmental disability (IDD) text.
2016 August 31 Chapter 24: Hospital Correction to ‘Update to Prior Authorization Requirements for CSHCN Services Program Emergency Hospital Admissions’
Information posted July 15, 2016
2016 August 31 Chapter 25: Laboratory Services Update to ‘Procedure Code 83861 to Become a Benefit for Optometrists’ Information posted July 22, 2016
2016 August 31 Appendix A: Acronyms Replaced mental retardation text with intellectual or developmental disability (IDD) text.
2016 July 29 Chapter 3: Client Benefits and Eligibility Updated Vendor Drug website hyperlinks in subsection 3.1, “Client Benefits”.
2016 July 29 Chapter 4: Prior Authorizations and Authorizations Added TPN authorization information to subsection 4.3.1, “Services that Require Prior Authorization.”
2016 July 29 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

TMHP to Accept and Process National Place of Service (POS) Code Values 17, 18, and 19 and Alpha POS Service Value Codes to No Longer Be Valid

Information posted March 9, 2016

2016 July 29 Chapter 16: Diagnostic Radiology Services

Benefits for Radiology Procedure Codes 77013, 77022, and 78608 to Change for the CSHCN Services Program

Information posted June 3, 2016

2016 July 29 Chapter 24: Hospital

Updated “Revenue Codes That Require Procedure Code” table in subsection 24.6.2.1, “Revenue Code and Procedure Code Requirements for All Outpatient Services”.

2016 July 29 Chapter 25: Laboratory Services

Therapeutic and Presumptive Drug Testing 2016 HCPCS Procedure Codes

Information posted May 31, 2016

2016 July 29 Chapter 26: Medical Nutrition Services

Removed section 26.6.2.2, Authorization Requirements - This information is duplicative of the information in Section 26.6.2.1, Prior Authorization. Also the statement "TPN may be approved for up to 12 months duration," is not valid.

Updated statements in sections 26.6.2 and 26.6.2.1 to align with Total Parenteral Nutrition policy.

2016 July 29 Chapter 30: Physical Medicine and Rehabilitation

Removed “rolling” from the applicable statements in Sections 30.2.2, Physical Therapy (PT), and Occupational Therapy (OT), and 30.2.2.1, Authorization Requirements; subsections Initial Prior Authorization Requests and Extension of Services Requests.

2016 July 29 Chapter 31: Physician

Updated website address in Section 31.2.24.15, “Respiratory Synctial Virus (RSV) Prophylaxis.”

2016 July 29 Chapter 36: Speech-Language Pathology (SLP) Services Removed “rolling” as a reference to days of services.
2016 June 30 Chapter 1: TMHP and DSHS Contact Information

TMHP Call Tree Options for 1-800-925-9126 Will Be Updated on May 16, 2016

Information posted May 13, 2016

2016 June 30 Chapter 4: Prior Authorizations and Authorizations

E-signatures and the Texas Medicaid Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form and the CSHCN Services Program Prior Authorization and Authorization Request for DME Form

Information posted April 1, 2016

2016 June 30 Chapter 9: Ambulance

Updated mileage and oxygen reimbursement information in sections 9.2, 9.4, and 9.5.6.

2016 June 30 Chapter 14: Dental

Update to CSHCN Services Program Provider Manual for Emergency Dental Procedure Code D9110

Information posted May 20, 2016

2016 June 30 Chapter 21: Home Health Services

Added clarifying language related to PT/OT/ST services to align with Phase I of comprehensive therapy reviews.

2016 June 30 Chapter 31: Physician

Echoencephalography Services to Change for the CSHCN Services Program

Information posted April 15, 2016

Updated Electrodiagnostic Testing Diagnosis Restrictions for Texas Medicaid and the CSHCN Services Program

Information posted May 27, 2016

Additional Benefits and Limitations for Botulinum Toxin Type A and Type B for the CSHCN Services Program Effective June 1, 2016

Information posted April 15, 2016

Procedure Code J1745 Reimbursed with Additional Diagnosis Codes

Information posted May 25, 2016
2016 June 30 Chapter 37: Telecommunication Services; Removed procedure code 97804 from Section 37.2.2.1, “Distant Site”.
2016 May 31 Chapter 18: Expendable Medical Supplies Update to Wound Care Supplies Table in the CSHCN Services Program Provider Manual

Information posted April 22, 2016
2016 May 31 Chapter 20: Hearing Services Updated procedure code type for 92552 in subsection 20.2.3.5, “Limitations.”
2016 May 31 Chapter 30: Physical Medicine and Rehabilitation Effective May 1, 2016, Physical Medicine and Rehabilitation Services to Change for the CSHCN Services Program

Information posted March 11, 2016

Updated policy language to mirror updates to Audit 02511 (per Code Validation Workgroup).
2016 May 31 Chapter 31:Physician Evoked Response Test and Neuromuscular Procedure Benefits to Change for the CSHCN Services Program

Information posted April 1, 2016

Botulinum Toxin Benefits to Change for the CSHCN Services Program

Information posted April 1, 2016

Some Additional Diagnosis Codes Payable for Procedure Code J1745 Infliximab

Information posted April 26, 2016
2016 May 31 Chapter 36: Speech Language Pathology Effective May 1, 2016, Speech-Language Pathology Services to Change for the CSHCN Services Program

Information posted March 11, 2016
2016 April 29 Chapter 5:Claims Filing and Reimbursement Description Change to Type of Service (TOS) 9

Information posted March 25, 2016
2016 April 29 Chapter 14: Dental Pulpotomy Limitation to Change April 1, 2016, for the CSHCN Services Program

Information posted February 15, 2016
2016 April 29 Chapter 25: Laboratory Services Urinalysis and Chemistry Services to Change for the CSHCN Services Program

Information posted March 11, 2016
2016 April 29 Chapter 28: Orthotic and Prosthetic Services Additional Payable Provider Type for Some Orthosis Procedure Codes Information posted March 4, 2016

Additional Payable Provider Type for Some Orthosis Procedure Codes Information posted March 4, 2016
2016 April 29 Chapter 31: Physician Removed sections 31.2.27.1 Physician Laboratory Services and 31.2.27.2 Laboratory Handling Fee.
2016 March 31 Chapter 9: Ambulance Effective April 1, 2016: E-Signatures Accepted, Fillable Forms Available, and New Prior Authorization Webpage for Prior Authorization and Authorization Requests

Information posted February 12, 2016
2016 March 31 Chapter 14: Dental Effective April 1, 2016: E-Signatures Accepted, Fillable Forms Available, and New Prior Authorization Webpage for Prior Authorization and Authorization Requests

Information posted February 12, 2016
2016 March 31 Chapter 16: Diagnostic Radiology Services Additional Payable Diagnosis Code for PET Procedure Code 78608

Information posted February 26, 2016
2016 March 31 Chapter 21: Home Health Services Added statement in Section 21.2.1.1, “Authorization Requirements,” relating to initial nursing assessment.

Revised statement removing “within” and replacing with “no earlier than” in section 21.2.1.2, “Plan of Care (POC).”
2016 March 31 Chapter 25: Laboratory Services Effective April 1, 2016: E-Signatures Accepted, Fillable Forms Available, and New Prior Authorization Webpage for Prior Authorization and Authorization Requests

Information posted February 12, 2016
2016 March 31 Chapter 26: Medical Nutrition Services Removed form update language from Section 26.4.2.1, “Prior Authorization Requirements.”
2016 March 31 Chapter 28: Orthotic and Prosthetic Devices Removed procedure code L2770 from table of section 28.3.2, “Orthotic and Orthopedic Devices Procedure Codes.”
2016 March 31 Chapter 31: Physician Effective April 1, 2016: E-Signatures Accepted, Fillable Forms Available, and New Prior Authorization Webpage for Prior Authorization and Authorization Requests

Information posted February 12, 2016
2016 March 31 Chapter 40: TMHP Electronic Data Interchange (EDI) Clarified contact information in subsection 40.6.1, “EDI Version 5010 Claims Response and Electronic Remittance & Status (R&S) Files.”
2016 February 29 Chapter1: TMHP and DSHS Contact Information Regions 9/10 – El Paso Office manager name updated. Office manager name updated.
2016 February 29 Chapter 7: Appeals and Administrative Review Clarified that CSHCN Services Program client identification number is needed.
2016 February 29 Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) Clean up to language in table of “General Medical Services.”

Revised the word “Preventative” to “Preventive” in the table header title of “Preventive Care Medical Checkups.” 
2016 February 29 Chapter 21: Home Health Services Revised statements in Section 21.2.1.2, “Plan of Care (POC)” to align with Home Health Services.
2016 February 29 Chapter 25: Laboratory Services January 2016 First Quarter NCCI Updates
Information posted January 25, 2016

Pathology and Laboratory Services for Hematology and Coagulation to Change for the CSHCN Services Program February 1, 2016
Information posted January 13, 2016

Pathology and Laboratory Services for Organ or Disease Oriented Panels to Change for the CSHCN Services Program February 1, 2016
Information posted January 15, 2016
2016 February 29 Chapter 26: Medical Nutrition Services Grammar and punctuation clean up to Section 26.2.2, “Benefits, Limitations, and Authorization Requirements.”

Changed the word “workbook” to “chapter” in Section 26.3.2.1, “Prior Authorization Requirements.”
2016 February 29 Chapter 31: Physician Additional Immunization Information Available for the CSHCN Services Program

Information posted January 29, 2016
2016 January 29 Chapter 2: Provider Enrollment and Responsibilities Added new section 2.1.8, “Pharmacy Enrollment” to the Provider Enrollment chapter.
2016 January 29 Chapter 14: Dental 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015
2016 January 29 Chapter 16: Diagnostic Radiology Services 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015
2016 January 29 Chapter 17: Durable Medical Equipment (DME) Benefits to Change for Diagnostic and Surgical/Reconstructive Breast Therapies and Corrective Procedures January 1, 2016

Information posted November 13, 2015
2016 January 29 Chapter 20: Hearing Services 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015
2016 January 29 Chapter 21: Home Health Services 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015
2016 January 29 Chapter 24: Hospital 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015

Magnetoencephalography (MEG) to Become a Benefit of the CSHCN Services Program January 1, 2016

Information posted on November 13, 2015 
2016 January 29 Chapter 25: Laboratory Services 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015

Benefit Criteria to Change for PLS Drug Testing and Therapeutic Drug Assays November 1, 2015

Information posted September 11, 2015

Microbiology Services to Change for the CSHCN Services Program

Information posted November 13, 2015
2016 January 29 Chapter 27: Neurostimulator Devices and Supplies 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015
2016 January 29 Chapter 31: Physician 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015

Magnetoencephalography (MEG) to Become a Benefit of the CSHCN Services Program January 1, 2016 I

nformation posted on November 13, 2015

Benefits to Change for Diagnostic and Surgical/Reconstructive Breast Therapies and Corrective Procedures January 1, 2016

Information posted November 13, 2015

Reimbursement Rate Changes and Updates for Rural Hospital Imaging to Be Effective September 1, 2015, for Texas Medicaid and CSHCN Program Services

Information posted on December 4, 2015 
2016 January 29 Chapter 33: Radiation Therapy Services 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015
2016 January 29 Chapter 35: Respiratory Equipment and Supplies 2016 HCPCS Special Bulletin No. 9

Information posted on December 30, 2015
2016 January 29 Chapter 39: Vision Services Benefits for Nonsurgical Vision Services to Change for the CSHCN Services Program January 1, 2016

Information posted November 20, 2015 
2016 January 29 Chapter 40: TMHP Electronic Data Interchange (EDI) Reminder: Beginning December 12, 2015, Internet Explorer 11 Must Be Used to Access TMHP Applications Available on this Website

Information posted November 20, 2015
2015 December 30 Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) Preventive Care Medical Checkup Benefit Criteria to Change for the CSHCN Services Program Effective November 1, 2015

Information posted September 11, 2015
2015 December 30 Chapter 24: Hospital Reimbursement Rate Changes and Updates for Rural Hospital Imaging to Be Effective September 1, 2015, for Texas Medicaid and CSHCN Services Program

Information posted December 4, 2015
2015 December 30 Chapter 31: Physician Clarification to ‘Pharmacy Delivery Method for Physician Administered Drugs’

Information posted November 13, 2015

 
   
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