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2019 CSHCN Release Notes

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The following tables show the section and handbooks that were changed in the Texas Medicaid Provider Procedures Manual in 2019. The changes are listed in reverse chronological order (newest first).

For a list of changes made in 2018, see the 2018 Release Notes.

December 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 1: TMHP and HHSC Contact Information

Removed the language “Specialty Health Care Services” and updated CSHCN fax number 1-800-441-5133 to 1-512-776-7238.

Chapter 2: Provider Enrollment and Responsibilities

Removed the language “Specialty Health Care Services” and updated CSHCN fax number 1-800-441-5133 to 1-512-776-7238.

Chapter 4: Prior Authorizations and Authorizations

Expendable Medical Supplies Request Forms for the CSHCN Services Program
Information posted December 13, 2019

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

Removed the language “Specialty Health Care Services” and updated CSHCN fax number 1-800-441-5133 to 1-512-776-7238.

Chapter 14: Dental

Sign Language Interpreting Services for CSHCN Services Program Dentist Providers
Information posted November 27, 2019

Chapter 18: Expendable Medical Supplies

Expendable Medical Supplies Request Forms for the CSHCN Services Program
Information posted December 13, 2019

Chapter 35: Renal Dialysis

Update to CSHCN Services Program Provider Manual Renal Dialysis Services Chapter
Information posted November 22, 2019

 

November 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 2: Provider Enrollment and Responsibilities

Update to Timeframe Requirements for Provider Maintenance Files
Information posted October 24, 2019

Replaced incorrect fax number from subsection 2.2, “Provider Complaints Process,” with TMHP-CSHCN client number. Made other quality review updates in subsection 2.3.10.2, “Abuse and Neglect Reporting Requirements.”

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

Removed old date of service from subsection 5.1.3, “CPT and HCPCS Claims Auditing Guidelines.” Updated example dates to more current year in subsections 5.7.2.16, “Dates on Claims” and 5.7.2.17, “Span Dates.”

Revised claims filing deadline dates for Thanksgiving day and the day after Thanksgiving.

Removed ICD-9 information from table in subsection 5.7.2.4, “CMS-1500 Paper Claim Form Instructions.”

Revised language and removed ICD-9 information from table to align with current ADA instructions in subsection 5.7.2.13, “Instructions for Completing the Paper ADA Dental Claim Form.”

Services Rendered by a Substitute Dentist May Be Billed to TMHP Utilizing Modifier U5, Effective Jan. 1, 2018
Information posted November 17, 2019

Chapter 11: Blood Pressure Devices and Supplies

2019 ICD-10 Special Bulletin No.16
Information posted September 30, 2019

Chapter 15: Diabetic Equipment and Supplies

Update to CSHCN Services Program Provider Manual
Information posted October 25, 2019

Chapter 20: Hearing Services

Update to CSHCN Services Program Provider Manual
Information posted October 25, 2019 

Chapter 24: Hospital

Removed language regarding addresses on neonatal claim submissions in subsection 24.3.1.7.2, “Other Requirements.”

Chapter 25: Laboratory Services

2019 ICD-10 Special Bulletin No.16
Information posted September 30, 2019

Chapter 31: Physician

2019 ICD-10 Special Bulletin No.16
Information posted September 30, 2019

Third Quarter 2019 HCPCS Updates for the CSHCN Services Program
Information posted September 27, 2019   

Removed duplicate text in “refer to” statement of subsection 31.2.39.2.5, “Excision or Destruction of Benign Lesions,” per recommendation of the Code Validation Workgroup for comprehensive review of Audit 02330.

Chapter 36: Respiratory Equipment and Supplies

Update to CSHCN Services Program Provider Manual
Information posted October 25, 2019

Chapter 40: Vision Services

Update to CSHCN Services Program Provider Manual
Information posted October 25, 2019 

 

October 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 2: Provider Enrollment and Responsibilities

Removed CMS broken website link from section 2.1.7, “Transplant Specialty Centers.”

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

Removed CMS broken website link from subsection 5.6.2.2, “National Correct Coding Initiatives (NCCI) Guidelines.”

Updated CMS website link in subsection 5.6.2.5, “Drug Rebate Program.”

Chapter 24: Hospital

Removed CMS broken website link from subsection 24.3.1.5, “Renal (Kidney) Transplant.”

 

September 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

Updated Version of the American Dental Association Claim Form Now Available
Information to post August 30, 2019

Chapter 9: Ambulance

Correction to ‘Prior Authorization Requirements and Instructions Update for Ambulance Transportation Services’
Information posted June 21, 2019

Chapter 14: Dental

Updated Version of the American Dental Association Claim Form Now Available
Information to post August 30, 2019

Chapter 35: Renal Dialysis

Removed procedure code J0606 from subsection 35.3.1, “In-Facility Services and Method I Home Dialysis Services,” as procedure code J0606 is not a benefit.

 

August 2019 CSHCN Release Notes

No updates for August 2019.

 

July 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

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.

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

TMHP to Update National Place of Service Code Value 57
Information posted May 20, 2019

Chapter 25: Laboratory Services

Updated Limitation for Zika Virus Testing Effective July 1, 2019
Information posted May 17, 2019

 

June 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 3: Client Benefits and Eligibility

Added language regarding prior authorizations to subsection 3.1.1, “Prescription Drug Benefits.”

Chapter 24: Hospital

Added references to subsection 24.4.1.1, “Blood Factor Products.”

Chapter 26: Medical Nutrition Services

Update to CSHCN Services Program Provider Manual Medical Nutrition Services Chapter
Information posted May 10, 2019

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.

 

May 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

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.

 

April 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

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

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.”

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

 

March 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 7: Appeals and Administrative Review

Updated prior authorization addresses and fax numbers throughout section 7.2, “Authorization and Prior Authorization Denials.”

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.”

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.”

Chapter 35: Renal Dialysis

Added a statement regarding claims filing in subsection 35.3.1, “In-Facility Services and Method I Home Dialysis Services.”

Chapter 38: Telecommunication Services

Overview of Telemonitoring Benefit Changes for the CSHCN Services Program
Information posted February 26, 2019

 

February 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

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.

Chapter 3: Client Benefits and Eligibility

Updated hyperlinks regarding CSHCN Services Program Physician/Dentist Assessment Form (PAF) throughout chapter.

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.”

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

Chapter 16: Diagnostic Radiology Services

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

 

Chapter 17: Durable Medical Equipment (DME)

CSHCN DME Providers to Require a Modifier for Standing Frame or Table
Information posted December 21, 2018

 

Chapter 18: Expendable Medical Supplies

Correction to the CSHCN Services Program Provider Manual for Expendable Medical Supplies
Information posted December 14, 2018

 

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

Chapter 20: Hearing Services

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Chapter 23: Hospice

Update to CSHCN Services Program Provider Manual for Hospice Services
Information posted December 14, 2018

Chapter 24: Hospital

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Chapter 25: Laboratory Services

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Chapter 27: Neurostimulators and Neuromuscular Stimulators

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Chapter 29: Outpatient Behavioral Health

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

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.

Chapter 35: Renal Dialysis

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Chapter 36: Respiratory Equipment and Supplies

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Chapter 40: Vision Services

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

 

January 2019 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 3: Client Benefits and Eligibility

Revised “abuse” as “use” in subsection 3.1.5, “CSHCN Services Program Services and Supplies Limitations and Exclusions.”

Chapter 4: Prior Authorizations and Authorizations

Updated claims filing deadline calendar links in subsection 4.1, “General Information.”

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.”

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.”

Chapter 9: Ambulance

Updated “Medicaid-enrolled” to “CSHCN Services Program-enrolled” in subsection 9.4.1, “Nonemergency Prior Authorizations.”

Chapter 14: Dental

Portability Permits No Longer Required for Dentists with Anesthesia or Sedation Permits Effective January 1, 2019
Information posted November 16, 2018

Chapter 18: Expendable Medical Supplies

Procedure Code T4528 with Modifier U1 No Longer a Benefit January 1, 2019
Information posted November 16, 2018

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

Chapter 20: Hearing Services

Revised ECI language regarding referrals in subsection 20.2.2, “Abnormal Hearing Screens.”

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.”