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 CSHCN Services Program Provider Manual - Release Notes 2018

The following table shows the chapters that were changed in the CSHCN Services Program Provider Manual in 2018. 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.

2017 Release Notes

Date

Section

Comments and Links to Related Articles

2018 September 14 Chapter 2: Provider Enrollment and Responsibilities Provider Practice Location Requirements for Moderate and High Risk Providers; PEP Enhancement for Facilities that Require Licensure, Effective August 24, 2018
Information posted July 6, 2018
2018 September 14 Chapter 4: Prior Authorizations and Authorizations Providers are Required to Fax Client Prior Authorization Requests Separately
Information posted July 18, 2018
2018 August 15 Chapter 14: Dental Dental Benefits to Change for Procedure Codes D4260 and D4261 for Texas Medicaid and CSHCN, Effective August 1, 2018
Information posted July 13, 2018
2018 August 15 Chapter 20: Hearing Services Reminder: Cochlear Implants Rechargeable Lithium-Ion Batteries Procedure Codes L8623 and L8624 Limited to Two per Calendar Year for CSHCN
Information posted July 20, 2018
2018 August 15 Chapter 25: Laboratory Services Quarterly Updates and Claims Reprocessing for Some CLIA Procedure Codes
Information posted June 22, 2018
2018 August 15 Chapter 29: Outpatient Behavioral Health Update to TMPPM and CSHCN Services Program Provider Manual for Psychiatric Diagnostic Evaluations
Information posted July 20, 2018

Updated broken NCCI link in section 29.2.10, “National Correct Coding Initiative (NCCI) Guidelines.”
2018 August 15 Chapter 35: Renal Dialysis Quarterly Updates and Claims Reprocessing for Some CLIA Procedure Codes
Information posted June 22, 2018
2018 July 13 Chapter 3: Client Benefits and Eligibility Updated broken Physician/Dentist Assessment Form (PAF) links in subsection 3.1.5, “CSHCN Services Program Services and Supplies Limitations and Exclusions,” subsection 3.2.2, “Eligibility Criteria,” subsection 3.2.9, “Medical Eligibility Criteria and the Physician/Dentist Assessment Form (PAF),” subsection 3.2.9.3, “Important Considerations When Completing the PAF,” and section 3.9, “Waiting List Information”.
2018 July 13 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement Updated broken NCCI link in subsection 5.1.4, “CMS NCCI and MUE Guidelines for All Claims,” and subsection 5.6.2.2, “National Correct Coding Initiative (NCCI) Guidelines.”
2018 July 13 Chapter 8: Advanced Practice Registered Nurse (APRN [NP/CNS]) Updated NCCI link per CMS website in section 8.3, “Claims Information.”
2018 July 13 Chapter 9: Ambulance Updated broken NCCI link in subsection 9.8.1.4, “National Correct Coding Initiative (NCCI) guidelines.”
2018 July 13 Chapter 10: Augmentative Communication Devices (ACDs) Updated broken NCCI link in section 10.3, “Claims Information.”
2018 July 13 Chapter 11: Blood Pressure Devices and Supplies Updated broken NCCI link in section 11.4, “Claims Information.”
2018 July 13 Chapter 12: Certified Registered Nurse Anesthetist (CRNA) Updated NCCI link per CMS website in section 12.3, “Claims Information.”
2018 July 13 Chapter 13: Certified Respiratory Care Practitioner (CRCP) Updated broken NCCI link in section 13.3, “Claims Information.”
2018 July 13 Chapter 15: Diabetic Equipment and Supplies Updated broken NCCI link in section 15.4, “Claims Information.”
2018 July 13 Chapter 17: Durable Medical Equipment (DME) Updated broken NCCI link in section 17.6, “Claims Information.”
2018 July 13 Chapter 18: Expendable Medical Supplies Updated broken NCCI link in section 18.3, “Claims Information.”
2018 July 13 Chapter 20: Hearing Services Updated broken NCCI link in section 20.4, “Claims Information.”
2018 July 13 Chapter 22: Home Health (Skilled Nursing) Care Updated NCCI link per CMS website in section 22.3, “Claims Information.”
2018 July 13 Chapter 23: Hospice Updated broken NCCI link in section 23.3, “Claims Information.”
2018 July 13 Chapter 24: Hospital Updated broken NCCI link in section 24.6, “Claims Information.”
2018 July 13 Chapter 25: Laboratory Services Updated broken NCCI link in section 25.3, “Claims Information.”
2018 July 13 Chapter 26: Medical Nutrition Services Updated NCCI link per CMS website in section 26.6.3, “Claims Information.”
2018 July 13 Chapter 27: Neurostimulators and Neuromuscular Stimulators Updated NCCI link per CMS website in section 27.3, “Claims Information.”
2018 July 13 Chapter 28: Orthotic and Prosthetic Devices Updated NCCI link per CMS website in section 28.7, “Claims Information.”
2018 July 13 Chapter 30: Physical Medicine and Rehabilitation Updated NCCI link per CMS website in section 30.4, “Claims Information.”
2018 July 13 Chapter 31: Physician Anesthesia Reimbursement Benefit Language Clarified for CSHCN Effective July 1, 2018
Information posted June 25, 2018

Influenza Vaccine Procedure Code 90682 to Become a Benefit of the CSHCN Services Program July 1, 2018
Information posted June 8, 2018

Mental Health Screenings to Change for CSHCN Effective July 1, 2018
Information posted June 15, 2018

Postpartum Depression Screening during an Infant’s Preventive Care Medical Checkup to Become a Benefit of the CSHCN Services Program July 1, 2018
Information posted June 22, 2018

Updated links for the Reportable Events Table and documentation for providers per the VAERS website in section 31.2.24.2.2, “Vaccine Adverse Event Reporting System (VAERS).”
2018 July 13 Chapter 32: Physician Assistant (PA) Updated NCCI link per CMS website in section 32.3, “Claims Information.”
2018 July 13 Chapter 34: Radiation Therapy Services Updated broken NCCI link in section 34.3, “Claims Information.”
2018 July 13 Chapter 35: Renal Dialysis Update to Drugs Included in Method I Composite Rate
Information posted June 29, 2018

Updated broken NCCI link in section 35.4, “Claims Information.”
2018 July 13 Chapter 36: Respiratory Equipment and Supplies Updated broken NCCI link in section 36.3, “Claims Information.”
2018 July 13 Chapter 37: Speech-Language Pathology (SLP) Services Updated broken NCCI link in section 37.4, “Claims Information.”
2018 July 13 Chapter 38: Telecommunication Services Updated NCCI link per CMS website in section 38.3, “Claims Information.”
2018 July 13 Chapter 40: Vision Services Updated broken NCCI link in section 40.3, “Claims Information.”
Updated the vision care eyeglass client certification form broken link in subsection 4.2.1.5, “Eye Wear” and added “refer to” with English and Spanish links.
2018 June 15 Chapter 10: Augmentative Communication Devices (ACDs) Added prior authorization form statement to section 10.2.1.1, “Prior authorization requirements for purchase or rental.”
2018 June 15 Chapter 13: Certified Respiratory Care Practitioner (CRCP) Added the word “form” to the prior authorization form statement in section 13.2.1, “Prior Authorization Requirements.”
2018 June 15 Chapter 20: Hearing Services Added prior authorization form statement to section 20.3.1.2, “Bone-Anchored Hearing Aid (BAHA).”
Added prior authorization form statement to section 20.3.2.4, “Authorization Requirements.”
2018 June 15 Chapter 21: Home Health Services Added prior authorization form statements to section 21.3.5, “Medical Nutritional Counseling Services,” and section 21.3.6.1, “Prior Authorization for Social Work Services.”
2018 June 15 Chapter 24: Hospital Added the word “form” to the prior authorization form statement in section 24.3.1.4.1, “Inpatient Rehabilitation Prior Authorization Requirements.”
Updated link in section 24.3.1.5, “Renal (Kidney) Transplants.”
2018 June 15 Chapter 25: Laboratory Services Updated prior authorization language in section 25.2.5.4.1, “Authorization Requirements.”
2018 June 15 Chapter 26: Medical Nutrition Services Added the word “form” to the prior authorization form statement in section 26.3.2.1, “Prior Authorization Requirements.”
2018 June 15 Chapter 28: Orthotic and Prosthetic Devices Added prior authorization form statement to section 28.3.9.2.2, “Authorization Requirements.”
2018 June 15 Chapter 29: Outpatient Behavioral Health Added prior authorization form statement to section 29.2.7.1, “Treatment for Alzheimer’s and Dementia.”
2018 June 15 Chapter 31: Physician Added prior authorization form statement to section 31.2.8.3, “Authorization Requirements.”
Revised prior authorization form title in section 31.2.13.2.3, “Non Face-to-Face Specialist or Subspecialist Telephone Consultations.”
Added prior authorization form statement to section 31.2.25.12.1, “Authorization Requirements.”
Updated prior authorization statement in the table of section 31.2.25.3, “Injection Procedure Codes.”
Revised prior authorization form title in section 31.2.28.1, “Authorization Requirements.”
Added prior authorization form statement to section 31.2.37.3, “Pediatric Pneumogram.”
2018 May 15 Chapter 9: Ambulance Updated Ambulance Services Prior Authorization Requirements and Forms, Effective May 1, 2018
Information posted March 9, 2018
2018 May 15 Chapter 31: Physician First Quarter 2018 HCPCS Updates for the CSHCN Services Program
Information posted March 30, 2018
2018 April 13 Chapter 2: Provider Enrollment and Responsibilities Updated Provider Information Management System PIC Form Now Available
Information posted Nov. 21, 2017
2018 April 13 Chapter 21: Home Health Services Update to CSHCN Services Program Provider Manual for Home Health Services
Information posted March 9, 2018
2018 March 15 Chapter 3: Client Benefits and Eligibility Grammar updates throughout chapter.
2018 March 15 Chapter 26: Medical Nutrition Services Reimbursement to Change for Procedure Codes B9998 and T1999 for the CSHCN Services Program
Information posted Feb. 9, 2018

Update to CSHCN Services Program Provider Manual for Medical Foods Reimbursement
Information posted Jan. 19, 2018
2018 March 15 Chapter 29: Outpatient Behavioral Health Correction to Outpatient Behavioral Health Services Procedure Code 90846 in the CSHCN Services Program Provider Manual
Information posted March 2, 2018
2018 February 15 Chapter 3: Client Benefits and Eligibility Updated the CSHCN Services Program Refund Information Form link in section 3.4 “Clients Eligible for Medicaid and CSHCN Services Program.”
Updated “spend down” references throughout chapter for consistency.
2018 February 15 Chapter 4: Prior Authorizations and Authorizations Correction to Prior Authorization and Authorization Fax Numbers in the CSHCN Services Program Provider Manual
Information posted Jan. 19, 2018
2018 February 15 Chapter 14: Dental Modifier for Dental General Anesthesia to Change Feb. 1, 2018 for the CSHCN Services Program
Information posted December 15, 2017

2018 HCPCS Special Bulletin No. 13
Information posted December 29, 2017
2018 February 15 Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) 2018 HCPCS Special Bulletin No. 13
Information posted December 29, 2017
2018 February 15 Chapter 20: Hearing Services 2018 HCPCS Special Bulletin No. 13
Information posted December 29, 2017
2018 February 15 Chapter 21: Home Health Services 2018 HCPCS Special Bulletin No. 13
Information posted December 29, 2017
2018 February 15 Chapter 25: Laboratory Services 2018 HCPCS Special Bulletin No. 13
Information posted December 29, 2017
2018 February 15 Chapter 28: Orthotic and Prosthetic Devices Cervical Orthoses Procedure Code L0113 to Become a Benefit of the CSHCN Services Program Effective Feb. 1, 2018
Information posted December 15, 2017

2018 HCPCS Special Bulletin No. 13
Information posted December 29, 2017
2018 February 15 Chapter 30: Physical Medicine and Rehabilitation 2018 HCPCS Special Bulletin No. 13
Information posted December 29, 2017
2018 February 15 Chapter 31: Physician 2018 HCPCS Special Bulletin No. 13
Information posted December 29, 2017

Modifier for Dental General Anesthesia to Change Feb. 1, 2018 for the CSHCN Services Program
Information posted December 15, 2017
2018 February 15 Chapter 34: Radiation Therapy Services 2018 HCPCS Special Bulletin No. 13
Information posted December 29, 2017
2018 January 15 Chapter 3: Client Benefits and Eligibility Rewrite of section 3.1.1, “Prescription Drug Benefits.”
Updated Vendor Drug link and CSHCN Services Program physician/dentist assessment form links throughout the chapter.
2018 January 15 Chapter 4: Prior Authorizations and Authorizations Updated filing deadline references and calendar links throughout chapter.
2018 January 15 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement Updated filing deadline references and calendar links throughout chapter.
2018 January 15 Chapter 7: Appeals and Administrative Review Updated filing deadline references and calendar links throughout chapter.
2018 January 15 Chapter 14: Dental Services Rendered by a Substitute Dentist May Be Billed to TMHP Utilizing Modifier U5, Effective Jan.1, 2018
Information posted Nov.17, 2017
2018 January 15 Chapter 25: Laboratory Services Updates and Claims Reprocessing for Some CLIA-Waived Lab Procedure Codes, Effective Jan. 1, 2018
Information posted Dec. 18, 2017
2018 January 15 Chapter 31: Physician Reimbursement Change for Anesthesia Services Provided by a Resident Physician under the Supervision of an Anesthesiologist Effective Nov. 1, 2017
Information posted Dec. 5, 2017

Chemotherapy Procedure Code G0498 to Become a Benefit for the CSHCN Services Program Effective Jan 1, 2018
Information posted Dec. 15, 2017

Updates and Claims Reprocessing for Some CLIA-Waived Lab Procedure Codes, Effective Jan.1, 2018
Information posted Dec. 18, 2017
2018 January 15 Chapter 35: Renal Dialysis Updates and Claims Reprocessing for Some CLIA-Waived Lab Procedure Codes, Effective Jan.1, 2018
Information posted Dec. 18, 2017
2017 December 15 Chapter 3: Client Benefits and Eligibility Updated the Notice of Eligibility sample and references throughout chapter.
2017 December 15 Chapter 4: Prior Authorizations and Authorizations Claims Submitted for Manually Priced Services Must Match Authorization Letter Details
Information posted December 1, 2017
2017 December 15 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement Removed and updated language for section 5.2.2, “CSHCN Services Program Notice of Eligibility.”

Claims Submitted for Manually Priced Services Must Match Authorization Letter Details
Information posted December 1, 2017
2017 December 15 Chapter 12: Certified Registered Nurse Anesthetist (CRNA) Reimbursement Change for Anesthesiologists Directing Certified Registered Nurse Anesthetists and Anesthesiologist Assistants
Information posted October 20, 2017
2017 December 15 Chapter 31: Physician Reimbursement Change for Anesthesiologists Directing Certified Registered Nurse Anesthetists and Anesthesiologist Assistants
Information posted October 20, 2017

Benefits to Change for Blood Factor Products Effective Dec. 1, 2017, for the CSHCN Services Program
Information posted Nov. 10, 2017

Chemodenervation Procedure Codes Will No Longer Require Prior Authorization for the CSHCN Services Program
Information posted Nov. 17, 2017

Infliximab Procedure Code Q5102 to Become a Benefit of the CSHCN Services Program Effective Dec. 1, 2017
Information posted Nov. 10, 2017
2017 December 15 Chapter 36: Respiratory Equipment and Supplies Benefit Criteria to Change for Respiratory Equipment and Supplies Effective March 1, 2017
Information posted January 3, 2017

 
   
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