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 CSHCN Services Program Provider Manual - Release Notes 2017

The following table shows the chapters that were changed in the CSHCN Services Program Provider Manual in 2017. 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.

2016 Release Notes

Date

Section

Comments and Links to Related Articles

2017 November 15 Chapter 4: Prior Authorizations and Authorizations Updated Prior Authorization fax number throughout the chapter.
2017 November 15 Chapter 9: Ambulance ICD-10 Special Bulletin No. 12
Information posted September 29, 2017
2017 November 15 Chapter 11: Blood Pressure Devices and Supplies ICD-10 Special Bulletin No. 12
Information posted September 29, 2017

2015 ICD-10 Bulletin, Special Bulletin No. 8
Information posted April 8, 2015
2017 November 15 Chapter 15: Diabetic Equipment and Supplies ICD-10 Special Bulletin No. 12
Information posted September 29, 2017
2017 November 15 Chapter 18: Expendable Medical Supplies ICD-10 Special Bulletin No. 12
Information posted September 29, 2017
2017 November 15 Chapter 25: Laboratory Services ICD-10 Special Bulletin No. 12
Information posted September 29, 2017

October 2017 Fourth Quarter NCCI Updates
Information posted October 4, 2017
2017 November 15 Chapter 27: Neurostimulators and Neuromuscular Stimulators ICD-10 Special Bulletin No. 12
Information posted September 29, 2017
2017 November 15 Chapter 31: Physician ICD-10 Special Bulletin No. 12
Information posted September 29, 2017

October 2017 Fourth Quarter NCCI Updates
Information posted October 4, 2017
2017 November 15 Chapter 40: Vision Services ICD-10 Special Bulletin No. 12
Information posted September 29, 2017
2017 October 15 Chapter 25: Laboratory Services

Some Laboratory Procedure Codes Type of Service Benefits to Change for CSHCN October 1, 2017
Information posted August 11, 2017

2017 October 15 Chapter 31: Physician

Magnetoencephalography Benefits to Change for Physician Providers for the CSHCN Services Program October 1, 2017
Information posted August 10, 2017

Physical, Occupational, and Speech Therapy Benefits to Change for CSHCN Effective September 1, 2017
Information posted July 12, 2017

Synagis Pharmacy Benefit Season to Begin October 2017
Information posted September 21, 2017

2017 October 15 Chapter 37: Speech-Language Pathology (SPL) Services

New Definition for Individual Speech Therapy Treatment for CSHCN Effective September 1, 2017
Information posted August 21, 2017

2017 September 15 Chapter: 10: Augmentative Communication Devices (ACDs) Added limitation for rentals of Augmentative Communication Devices (ACDs)
2017 September 15 Chapter 17: Durable Medical Equipment (DME) Follow Up to ‘Procedure Code 97542 to Become a Benefit for Seating Assessments for the CSHCN Services Program Effective September 1, 2017’
Information posted August 23, 2017
2017 September 15 Chapter 30: Physical Medicine and Rehabilitation Physical, Occupational, and Speech Therapy Benefits to Change for CSHCN Effective September 1, 2017
Information posted July 12, 2017
Prior Authorization Changes for Physical, Occupational, and Speech Therapy for CSHCN Effective September 1, 2017
Information posted August 8, 2017
2017 September 15 Chapter 33: Prescribed Pediatric Extended Care Centers Updated prior authorization form title to align with the title on the form in sections 33.2.1, ‘Prior Authorization and Authorization Requirements,” and 33.2.1.1, “Initial Prior Authorization Requests.”
2017 September 15 Chapter 35: Renal Dialysis Added limitation for dialysis training
2017 September 15 Chapter 37: Speech-Language Pathology (SLP) Services
New Definition for Individual Speech Therapy Treatment for CSHCN Effective September 1, 2017
Information posted August 21, 2017
2017 August 15 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement TMHP to Accept and Process National Place of Service Code Value 02
Information posted June 23, 2017
2017 August 15 Chapter 18: Expendable Medical Supplies Removed discontinued codes A6200, A6201, and A6202 from subsection 18.2.2, “Wound Care Supplies.”
2017 August 15 Chapter 31: Physician Placed diagnosis codes in the correct numerical order for procedure code J0586 31.2.25.7 Botulinum Toxin (Type A and Type B).
2017 July 14 Chapter 14: Dental Therapeutic Dental Benefits to Change for the CSHCN Services Program July 1, 2017
Information posted June 7, 2017
2017 July 14 Chapter 26: Medical Nutrition Services Added benefit limitation information for procedure code B9002 to section 26.5.2, Benefits, Limitations, and Authorization Requirements.
2017 July 14 Chapter 29: Outpatient Behavioral Health
Behavioral Health Services Benefit Criteria to Change for CSHCN Services Program, Effective July 1, 2017
Information posted May 12, 2017
2017 July 14 Chapter 31: Physician Therapeutic Dental Benefits to Change for the CSHCN Services Program July 1, 2017
Information posted June 7, 2017
2017 July 14 Chapter 33: Prescribed Pediatric Extended Care Centers
Created new chapter for PPECC services.
2017 June 15 Chapter 14: Dental Removed procedure codes from subsection 14.2.7.5, Radiology and Laboratory Procedures, per policy update.
2017 June 15 Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) Telemedicine and Telehealth Benefits to Change for the CSHCN Services Program June 1, 2017
Information posted April 28, 2017
2017 June 15 Chapter 25: Laboratory Services Zika Virus Testing Requires Modifier U4 on Claims
Information posted May 5, 2017
2017 June 15 Chapter 26: Medical Nutrition Services Added procedure code B9002 to the table of subsection 26.5.2, Benefits, Limitations, and Authorization Requirements.
2017 June 15 Chapter 31: Physician Removed statement with procedure code 90288 from subsection 31.2.24.12, Botulinum Antitoxin
2017 June 15 Chapter 37: Telecommunication Services Telemedicine and Telehealth Benefits to Change for the CSHCN Services Program June 1, 2017
Information posted April 28, 2017
2017 May 15 Chapter 1: TMHP and HHSC Contact Information Updated chapter title to “TMHP and HHSC Contact Information,” updated “DSHS-CSHCN Services Program” to “HHSC-CSHCN Services Program” and updated the email address in subsection 1.3.1, “Central Office.”
2017 May 15 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement Updated “DSHS manager” to “HHSC manager” in subsection 5.1.9, “Exception to Claim Filing Deadline.”
2017 May 15 Chapter 26: Medical Nutrition Services Updated “DSHS-CSHCN Medical Director or a designee” to “HHSC-CSHCN Services Program designee” in subsection 26.3.2.1, “Prior Authorization Requirements.”
2017 May 15 Chapter 27: Neurostimulator Devices and Supplies Updated “DSHS-CSHCN Medical Director or a designee” to “HHSC-CSHCN Services Program designee” throughout chapter.
2017 April 14 Chapter 1: TMHP and DSHS Contact Information Updated address from “Purchased Health Services Unit” to “Specialty Health Care Services” in subsection 1.1.2, “Written Communication with CSHCN Services Program”.
2017 April 14 Chapter 2: Provider Enrollment and Responsibilities Updated address from “Purchased Health Services Unit” to “Specialty Health Care Services” in subsection 1.1.2, “Written Communication with CSHCN Services Program”.
2017 April 14 Chapter 3: Client Benefits and Eligibility Updated address from “Purchased Health Services Unit” to “Specialty Health Care Services” in subsection 1.1.2, “Written Communication with CSHCN Services Program”.

Updated “CSHCN Services Program Application Booklet” to correct title “CSHCN Services Program Application”.

Updated “CSHCN Services Program Eligibility Form” to correct title “CSHCN Services Program Notice of Eligibility Form”.
2017 April 14 Chapter 4: Prior Authorizations and Authorizations Updated address from “Purchased Health Services Unit” to “Specialty Health Care Services” in subsection 1.1.2, “Written Communication with CSHCN Services Program”.
2017 April 14 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement Updated address from “Purchased Health Services Unit” to “Specialty Health Care Services” in subsection 1.1.2, “Written Communication with CSHCN Services Program”.

Updated “CSHCN Services Program Eligibility Form” to correct title “CSHCN Services Program Notice of Eligibility Form”.
2017 April 14 Chapter 7: Appeals and Administrative Review Updated address from “Purchased Health Services Unit” to “Specialty Health Care Services” in subsection 1.1.2, “Written Communication with CSHCN Services Program”.

Added 2017 filing calendar link to subsection 7.3, “Claims Appeals”.
2017 April 14 Chapter 14: Dental Updated section 14.2.2.5, “Radiographs or Diagnostic Imaging,” with limitations for procedure codes D0272, D0272, D0274, and D0277.
2017 April 14 Chapter 18: Expendable Medical Supplies Updated page number in subsection 18.2.1, “Diapers, Briefs, Pull-ups, and Liners”.

Added procedure code A4554 to the Wound Care Supplies table in subsection 18.2, “Benefits, Limitations, and Authorization Requirements”.
2017 April 14 Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) 2017 HCPCS Special Bulletin No. 11  
Information posted December 30, 2016
2017 April 14 Chapter 24: Hospital Additional Documentation for Prior Authorization Request for Inpatient Hospital Admission – For Use by Facilities Only Form
Information posted February 17, 2017
2017 April 14 Chapter 31: Physician Removed combination language statement under Section 31.2.5.7, “Time-Based Fees.” 

2017 HCPCS Special Bulletin No. 11  
Information posted December 30, 2016

New Benefit for the CSHCN Services Program: Monoclonal Antibodies – Asthma & Chronic Idiopathic Urticaria
Information posted February 1, 2017
2017 April 14 Chapter 35: Respiratory Equipment and Supplies Benefit Criteria to Change for CSHCN Respiratory Services Effective March 1, 2017
Information posted March 9, 2017
2017 February 28 Chapter 14: Dental Clarification for Preventive Dental Space Maintainers Lifetime Limitation for the CSHCN Services Program
Information posted February 3, 2017
2017 February 28 Chapter 25: Laboratory Services 2017 HCPCS Special Bulletin No. 11
Information posted December 30, 2016

Correction to the CSHCN Services Program Provider Manual  for Urinalysis and Chemistry Procedure Code 83518
Information posted February 27, 2017
2017 February 28 Chapter 31: Physician New Mental Health Screening Tool for the CSHCN Services Program
Information posted January 13, 2017
2017 February 28 Chapter 37: Telecommunication Services Effective February 1, 2017, Modifier 95 No Longer Required for Some Telemedicine or Telehealth Procedure Codes
Information posted January 27, 2017
2017 January 31 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement Corrected text in subsection 5.1.4, “CMS NCCI and MUE Guidelines for All Claims, from “application” to “applicable”.
2017 January 31 Chapter 6: Remittance and Status (R&S) Reports Changes to Outstanding Checks Process for Texas Medicaid and the CSHCN Services Program
Information posted December 30, 2016
2017 January 31 Chapter 12: Certified Registered Nurse Anesthetist (CRNA)

Reimbursement Reduction to Anesthesiologists Directing Certified Registered Nurse Anesthetists (CRNA) and or Anesthesiologist Assistants (AA)
Information posted December 2, 2016

2017 January 31 Chapter 14: Dental 2017 HCPCS Special Bulletin No. 11
Information posted December 30, 2016

Prior Authorization Requirements and Other Benefit Changes for Certain CSHCN Services Program Procedure Codes Effective January 1, 2017
Information posted December 16, 2016
2017 January 31 Chapter 15: Diabetic Equipment and Supplies 2017 HCPCS Special Bulletin No. 11
Information posted on January 6, 2017
2017 January 31 Chapter 17: Durable Medical Equipment (DME) 2017 HCPCS Special Bulletin No. 11
Information posted on January 6, 2017
2017 January 31 Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) 2017 HCPCS Special Bulletin No. 11
Information posted on January 6, 2017
2017 January 31 Chapter 24: Hospital Behavioral Health Services to Change for the CSHCN Services Program
Information posted November 11, 2017
2017 January 31 Chapter 25: Laboratory Services 2017 HCPCS Special Bulletin No. 11
Information posted December 30, 2016

Claims Reprocessing for Some Laboratory Services Procedure Codes Related to CLIA Certification and Modifier QW
Information posted January 20, 2017
2017 January 31 Chapter 28: Orthotic and Prosthetic Devices 2017 HCPCS Special Bulletin No. 11
Information posted December 30, 2016
2017 January 31 Chapter 29: Outpatient Behavioral Health Behavioral Health Services to Change for the CSHCN Services Program
Information posted November 11, 2017
2017 January 31 Chapter 30: Physical Medicine and Rehabilitation 2017 HCPCS Special Bulletin No. 11
Information posted December 30, 2016
2017 January 31 Chapter 31: Physician Reimbursement Reduction to Anesthesiologists Directing Certified Registered Nurse Anesthetists (CRNA) and or Anesthesiologist Assistants (AA)
Information posted December 2, 2016

2017 HCPCS Special Bulletin No. 11
Information posted December 30, 2016

Behavioral Health Services to Change for the CSHCN Services Program
Information posted November 11, 2017

Prior Authorization Requirements and Other Benefit Changes for Certain CSHCN Services Program Procedure Codes Effective January 1, 2017
Information posted December 16, 2016
2017 January 31 Chapter 37: Telecommunication Services 2017 HCPCS Special Bulletin No. 11
Information posted December 30, 2016

2017 HCPCS Update Telemedicine and Telehealth Services Required Modifier
Information posted December 29, 2016
2017 January 31 Chapter 39: Vision Services 2017 HCPCS Special Bulletin No. 11
Information posted December 30, 2016
2016 December 30 Chapter 14: Dental Typo identified - revised local code Z2008 to Z2009 in subsection 14.2.3.3, “Submitting Local Codes for Orthodontic Procedures.”
2016 December 30 Chapter 31: Physician

Omalizumab Benefit Criteria to Change for the CSHCN Services Program December 1, 2016
Information posted October 25, 2016

 
   
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