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 CSHCN Services Program Provider Manual - Release Notes 2019

The following table shows the chapters that were changed in the CSHCN Services Program Provider Manual in 2019. 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.

2018 Release Notes

Date

Section

Comments and Links to Related Articles

2019 July 15 Chapter 1: TMHP and HHSC Contact Information Removed language in subsection 1.1.4, “THMP-CSHCN Services Program Automated Inquiry System (AIS).” AIS user guide is no longer in use.
2019 July 15 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement TMHP to Update National Place of Service Code Value 57
Information posted May 20, 2019
2019 July 15 Chapter 25: Laboratory Services Updated Limitation for Zika Virus Testing Effective July 1, 2019
Information posted May 17, 2019
2019 June 14 Chapter 3: Client Benefits and Eligibility Added language regarding prior authorizations to subsection 3.1.1, “Prescription Drug Benefits.”
2019 June 14 Chapter 24: Hospital Added references to subsection 24.4.1.1, “Blood Factor Products.”
2019 June 14 Chapter 26: Medical Nutrition Services Update to CSHCN Services Program Provider Manual Medical Nutrition Services Chapter
Information posted May 10, 2019
2019 June 14 Chapter 31: Physician Removed the asterisk from procedure code 90650 in section 31.2.24.9, “Vaccine and Toxoid Procedure Codes,” as the vaccine is no longer available through the Texas Vaccines for Children (TVFC) Program.
For clarity added statement, “Claims for blood factor products use F2 as the unit of measurement,” to section 31.2.9, Blood Factor Products.
2019 May 15 Chapter 31: Physician Update to CSHCN Services Program Provider Manual Physician Chapter
Information posted April 26, 2019

Added reference at the end of section 31.2.9, “Blood Factor Products” to the Claims Filing, Third-Party Resources, and Reimbursement chapter for providers to obtain information about the required units of measurement codes.
2019 April 15 Chapter 15: Diabetic Equipment and Supplies Therapeutic Continuous Glucose Monitors to Become a Benefit of the CSHCN Services Program April 1, 2019
Information posted March 29, 2019
2019 April 15 Chapter 25: Laboratory Services Update to CSHCN Services Program Provider Manual for H. Pylori Testing
Information posted March 15, 2019
Updated limitations in subsection 25.2.9, “Helicobacter pylori (H.pyrlori)” for procedure codes 83009 and 86677 to “once per lifetime when submitted by any provider.”
2019 April 15 Chapter 31: Physician HPV2 and HPV4 No Longer Available Through TVFC Program
Information posted June 10, 2016
Wound Care Procedure Codes Q4186 and Q4187 are Benefits Effective January 1, 2019
Information posted March 29, 2019
2019 March 15 Chapter 7: Appeals and Administrative Review Updated prior authorization addresses and fax numbers throughout section 7.2, “Authorization and Prior Authorization Denials.”
2019 March 15 Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) Removed duplicate procedure codes 99385 and 99395 and rearranged procedure codes 99381, 99382, 99383, 99384, and 99391 to be placed in numerical order within the table of subsection 19.2.2, “Preventive Care Medical Checkups.”
2019 March 15 Chapter 31: Physician Effective March 1, 2019, New Prior Authorization Criteria for Inotuzumab Ozogamicin (Besponsa) for the CSHCN Services Program
Information posted February 1, 2019
Added the text “procedure codes” at the beginning of the set of codes within the parentheses of subsection 31.2.34, “Psychological Testing.”
2019 March 15 Chapter 35: Renal Dialysis Added a statement regarding claims filing in subsection 35.3.1, “In-Facility Services and Method I Home Dialysis Services.”
2019 March 15 Chapter 38: Telecommunication Services Overview of Telemonitoring Benefit Changes for the CSHCN Services Program
Information posted February 26, 2019
2019 February 15 Chapter 1: TMHP and HHSC Contact Information Removed “Bulletins—the CSHCN Services Program Provider Bulletin, the Long Term Care Provider Bulletin, and the Texas Medicaid Bulletin” from subsection 1.2.1, “Publications,” as this information is no longer created or posted.
2019 February 15 Chapter 3: Client Benefits and Eligibility Updated hyperlinks regarding CSHCN Services Program Physician/Dentist Assessment Form (PAF) throughout chapter.
2019 February 15 Chapter 4: Prior Authorizations and Authorizations Updated “NPI” to “TPI” in subsection 4.3.6, “Prior Authorization Electronic Submissions through the TMHP Prior Authorization (PA) on the Portal.”
2019 February 15 Chapter 14: Dental 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
Some Dental Restoration Procedure Codes are No Longer Benefits Effective January 1, 2019
Information posted December 27, 2018
2019 February 15 Chapter 16: Diagnostic Radiology Services 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 February 15 Chapter 17: Durable Medical Equipment (DME) CSHCN DME Providers to Require a Modifier for Standing Frame or Table
Information posted December 21, 2018
2019 February 15 Chapter 18: Expendable Medical Supplies Correction to the CSHCN Services Program Provider Manual for Expendable Medical Supplies
Information posted December 14, 2018
2019 February 15 Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 February 15 Chapter 20: Hearing Services 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 February 15 Chapter 23: Hospice Update to CSHCN Services Program Provider Manual for Hospice Services
Information posted December 14, 2018
2019 February 15 Chapter 24: Hospital 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 February 15 Chapter 25: Laboratory Services 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 February 15 Chapter 27: Neurostimulators and Neuromuscular Stimulators 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 February 15 Chapter 29: Outpatient Behavioral Health 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 February 15 Chapter 31: Physician 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
Removed Section 31.2.25.6, “Benralizumab,” and combined with the Monoclonal Antibodies ‐ Asthma and Chronic Idiopathic Urticaria medical policy, Section 31.2.25.16, to align with policy. Pages 78-79.
2019 February 15 Chapter 35: Renal Dialysis 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 February 15 Chapter 36: Respiratory Equipment and Supplies 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 February 15 Chapter 40: Vision Services 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018
2019 January 15 Chapter 3: Client Benefits and Eligibility Revised “abuse” as “use” in subsection 3.1.5, “CSHCN Services Program Services and Supplies Limitations and Exclusions.”
2019 January 15 Chapter 4: Prior Authorizations and Authorizations Updated claims filing deadline calendar links in subsection 4.1, “General Information.”
2019 January 15 Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement Updated claims filing deadline calendars/holiday calendar and links in subsection 5.1.8, “Claims Filing Deadlines,” and subsection 5.5, “Correction and Resubmission (Appeal) Time Limits.”
2019 January 15 Chapter 7: Appeals and Administrative Review Updated claims filing deadline calendar links in subsection 7.3, “Claims appeal,” and subsection 7.6, “Authorization and Filing Deadline Calendars.”
2019 January 15 Chapter 9: Ambulance Updated “Medicaid-enrolled” to “CSHCN Services Program-enrolled” in subsection 9.4.1, “Nonemergency Prior Authorizations.”
2019 January 15 Chapter 14: Dental Portability Permits No Longer Required for Dentists with Anesthesia or Sedation Permits Effective January 1, 2019
Information posted November 16, 2018
2019 January 15 Chapter 18: Expendable Medical Supplies Procedure Code T4528 with Modifier U1 No Longer a Benefit January 1, 2019
Information posted November 16, 2018
2019 January 15 Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) Update to CSHCN Services Program Provider Manual for Preventive Care Medical Checkups
Information posted January 11, 2019
2019 January 15 Chapter 20: Hearing Services Revised ECI language regarding referrals in subsection 20.2.2, “Abnormal Hearing Screens.”
2019 January 15 Chapter 31: Physician Revised “substance abuse” as “substance use” in subsection 31.2.18.10.2, “Mental Health Screening.”
Added “any provider” to the benefit limitation statement for procedure codes 96160 and 96161 in subsection 31.2.18.10.2, “Mental Health Screening.”

 
   
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