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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 December 14 Chapter 3: Client Benefits and Eligibility Added form names to the listed drugs and products in subsection 3.1.1, “Prescription Drug Benefits.”
2018 December 14 Chapter 4: Prior Authorizations and Authorizations Added and removed language throughout the chapter.
2018 December 14 Chapter 14: Dental Added TAC rule on sedation and anesthesia to section 14.1, “Enrollment.”
2018 December 14 Chapter 23: Hospice Updated “DADS” reference with appropriate agency name in section 23.1, “Enrollment.”
2018 December 14 Chapter 26: Medical Nutrition Services Removed the program name Health and Human Services Commission Texas Medicaid CHIP from the last statement in section 26.3.3, “Claims Information.”
2018 December 14 Chapter 31: Physician Removed DARS program in sections 31.2.6, “Audiometry/Hearing Services,” and 31.2.35, “Sign Language Interpreting Services,” and replaced with HHSC, as this agency is no longer referred to as DARS.
Revised statement in section 31.2.24.15, “Respiratory Syncytial Virus (RSV) Prophylaxis,” by removing Health and Human Services Commission and adding statement about prior authorization form submissions for RSV.
Update to ‘First Quarter 2018 HCPCS Updates for the CSHCN Services Program’
Information posted November 16, 2018
Quantity Limitation to Change for Botulinum Toxin Type A Procedure Code J0586
Information posted October 26, 2018
Revised statement in section 31.2.25.11, “Growth Hormone.” Removed Health and Human Services Commission Medicaid/CHIP, added prior authorization form name for Growth Hormone Products and updated link to Vendor Drug website; section 31.2.25.11.1, “Prior Authorization Requirements,” removed Texas Medicaid VDP and added prior authorization form name for Growth Hormone Products.
2018 December 14 Chapter 33: Prescribed Pediatric Extended Care Centers Removed DADS program and replaced with HHSC to be consistent with provider enrollment requirements in section 33.1, “Enrollment.”
2018 December 14 Chapter 36: Respiratory Equipment and Supplies Updated “DARS” reference with appropriate agency name in section 36.2, “Benefits, Limitations, and Authorization Requirements.”
2018 December 14 Chapter 40: Vision Services Updated “DARS” references with appropriate agency name.
2018 December 14 Appendix A: Acronyms Removed “DARS” reference from section A.1, “Acronym Dictionary.”
2018 November 15 Chapter 4: Prior Authorizations and Authorizations Updated language for emergency inpatient hospital admissions in section 4.3, “Prior Authorizations.”
2018 November 15 Chapter 16: Diagnostic Radiology Services 2018 ICD-10 Special Bulletin, No. 14
Information posted on September 28, 2018
2018 November 15 Chapter 18: Expendable Medical Supplies 2018 ICD-10 Special Bulletin, No. 14
Information posted on September 28, 2018
2018 November 15 Chapter 20: Hearing Services 2018 ICD-10 Special Bulletin, No. 14
Information posted on September 28, 2018
Hearing Services Benefits to Change for the CSHCN Services Program, Effective November 1, 2018
Information posted October 12, 2018
2018 November 15 Chapter 25: Laboratory Services 2018 ICD-10 Special Bulletin, No. 14
Information posted on September 28, 2018
2018 November 15 Chapter 26: Medical Nutrition Services 2018 ICD-10 Special Bulletin, No. 14
Information posted on September 28, 2018
2018 November 15 Chapter 31: Physician 2018 ICD-10 Special Bulletin, No. 14
Information posted on September 28, 2018
2018 November 15 Chapter 40: Vision Services 2018 ICD-10 Special Bulletin, No. 14
Information posted on September 28, 2018
2018 October 15 Introduction Updated language to add “International classification of Disease” to section 1.2, “About the Provider Manual.”
2018 October 15 Chapter 11: Blood Pressure Devices and Supplies Removed diagnosis code descriptions in section 11.2.1.2, “Manual and Automated Blood Pressure Devices.”
Removed procedure code descriptions in section 11.2.2.4, “Blood Pressure Device Components Repair or Replacement.”
2018 October 15 Chapter 15: Diabetic Equipment and Supplies Removed diagnosis code descriptions in sections 15.2.1, “Glucose Monitor and Supplies,” and 15.2.1.1, “Non Diabetic Diagnosis Codes.”
2018 October 15 Chapter 16: Diagnostic Radiology Services Removed diagnosis code descriptions in section 16.2.9, “Positron Emission Tomography (PET).”
2018 October 15 Chapter 18: Expendable Medical Supplies Removed diagnosis code descriptions in section Appendix A, “Diagnosis Codes for Diapers, Briefs, Pull-Ups, and Liners.”
2018 October 15 Chapter 24: Hospital Revised CSHCN Services Program Prior Authorization Request for Inpatient Hospital Admission-For Use by Facilities Only Form Instructions, Effective October 1, 2018
Information posted September 21, 2018
Neonatal Level of Care Designation Required for Hospital Providers Rendering Neonatal Inpatient Services
Information posted July 6, 2018
Removed diagnosis code descriptions in section 24.4.1.1, “Blood Factor Products.”
2018 October 15 Chapter 25: Laboratory Services Removed diagnosis code descriptions in section 25.2.5.2, “Cytogenetics Testing.”
2018 October 15 Chapter 26: Medical Nutrition Services Removed procedure code description in section 26.4.4, “Reimbursement.”
2018 October 15 Chapter 27: Neurostimulators and Neuromuscular Stimulators Global Update - removed the diagnosis description column from the tables of sections 27.2.1, “Dorsal Column Neurostimulation (DCN),” 27.2.2, “Intracranial Neurostimulation (ICN),” and 27.2.4, “Percutaneous Electrical Nerve Stimulation (PENS).”
2018 October 15 Chapter 29: Outpatient Behavioral Health Removed diagnosis code descriptions in section 29.2.7.1, “Treatment for Alzheimer’s and Dementia.”
2018 October 15 Chapter 31: Physician Global Update - removed the diagnosis description column from the tables. Also removed diagnosis descriptions listed within statements. The following sections were updated: 31.2.2, “Aerosol Treatments/Inhalation Therapy,” 31.2.9, “Blood Factor Products,” 31.2.11, “Casting,” 31.2.17, “Echoencephalography,” 31.2.17.1, “Ambulatory Electroencephalogram,” 31.2.18.8, “Preventive Care Services,” 31.2.19.2, “Electromyography and Nerve Conduction Studies,” 31.2.20, “Extracorporeal Shock Wave Lithotripsy (ESWL),” 31.2.24.6, “Immunizations During an Office Visit,” 31.2.24.9, “Vaccine and Toxoid Procedure Codes,” 31.2.24.12, “Botulinum Antitoxin,” 31.2.25.3, “Injection Procedure Codes,” 31.2.25.6, “Bevacizumab,” 31.2.25.7, “Botulinum Toxin (Type A and Type B),” 31.2.25.10, “Erythropoietin Alfa (EPO) and Darbepoetin,” 31.2.36, “Skin Therapy,” 31.2.37.1, “Polysomnography,” 31.2.37.2, “Multiple Sleep Latency Test,” 31.2.37.3, “Pediatric Pneumogram,” 31.2.37.4, “Home Sleep Study Test,” 31.2.39.8, “Rhizotomy,” and 31.2.40, “Therapeutic Apheresis.”
2018 October 15 Chapter 34: Radiation Therapy Services Removed diagnosis code descriptions in section 34.2.9, “Strontium-89.”
2018 October 15 Chapter 38: Telecommunication Services Update to TMPPM and CSHCN Services Program Provider Manual for Texas Medicaid Wellness Program
Information posted on September 7, 2018
2018 October 15 Chapter 40: Vision Services Removed diagnosis code descriptions in sections 40.2.1.4, “Contact Lenses,” and 40.2.3.3, “Corneal Topography.”
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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