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 |
Removed the language “Specialty Health Care Services” and updated CSHCN fax number 1-800-441-5133 to 1-512-776-7238. |
|
Removed the language “Specialty Health Care Services” and updated CSHCN fax number 1-800-441-5133 to 1-512-776-7238. |
|
Expendable Medical Supplies Request Forms for the CSHCN Services Program |
|
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. |
Sign Language Interpreting Services for CSHCN Services Program Dentist Providers |
|
Expendable Medical Supplies Request Forms for the CSHCN Services Program |
|
Update to CSHCN Services Program Provider Manual Renal Dialysis Services Chapter |
November 2019 CSHCN Release Notes |
|
Chapter |
Related Articles and Notes |
Update to Timeframe Requirements for Provider Maintenance Files 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 |
2019 ICD-10 Special Bulletin No.16 |
|
Update to CSHCN Services Program Provider Manual |
|
Update to CSHCN Services Program Provider Manual |
|
Removed language regarding addresses on neonatal claim submissions in subsection 24.3.1.7.2, “Other Requirements.” |
|
2019 ICD-10 Special Bulletin No.16 |
|
2019 ICD-10 Special Bulletin No.16 Third Quarter 2019 HCPCS Updates for the CSHCN Services Program 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. |
|
Update to CSHCN Services Program Provider Manual |
|
Update to CSHCN Services Program Provider Manual |
October 2019 CSHCN Release Notes |
|
Chapter |
Related Articles and Notes |
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.” |
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 |
Correction to ‘Prior Authorization Requirements and Instructions Update for Ambulance Transportation Services’ |
|
Updated Version of the American Dental Association Claim Form Now Available |
|
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 |
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 |
Updated Limitation for Zika Virus Testing Effective July 1, 2019 |
June 2019 CSHCN Release Notes |
|
Chapter |
Related Articles and Notes |
Added language regarding prior authorizations to subsection 3.1.1, “Prescription Drug Benefits.” |
|
Added references to subsection 24.4.1.1, “Blood Factor Products.” |
|
Update to CSHCN Services Program Provider Manual Medical Nutrition Services Chapter |
|
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 |
Update to CSHCN Services Program Provider Manual Physician Chapter 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 |
Therapeutic Continuous Glucose Monitors to Become a Benefit of the CSHCN Services Program April 1, 2019 |
|
Update to CSHCN Services Program Provider Manual for H. Pylori Testing 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.” |
|
HPV2 and HPV4 No Longer Available Through TVFC Program Wound Care Procedure Codes Q4186 and Q4187 are Benefits Effective January 1, 2019 |
March 2019 CSHCN Release Notes |
|
Chapter |
Related Articles and Notes |
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.” |
Effective March 1, 2019, New Prior Authorization Criteria for Inotuzumab Ozogamicin (Besponsa) for the CSHCN Services Program Added the text “procedure codes” at the beginning of the set of codes within the parentheses of subsection 31.2.34, “Psychological Testing.” |
|
Added a statement regarding claims filing in subsection 35.3.1, “In-Facility Services and Method I Home Dialysis Services.” |
|
Overview of Telemonitoring Benefit Changes for the CSHCN Services Program |
February 2019 CSHCN Release Notes |
|
Chapter |
Related Articles and Notes |
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. |
|
Updated hyperlinks regarding CSHCN Services Program Physician/Dentist Assessment Form (PAF) throughout chapter. |
|
Updated “NPI” to “TPI” in subsection 4.3.6, “Prior Authorization Electronic Submissions through the TMHP Prior Authorization (PA) on the Portal.” |
|
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Some Dental Restoration Procedure Codes are No Longer Benefits Effective January 1, 2019 |
|
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
|
|
CSHCN DME Providers to Require a Modifier for Standing Frame or Table
|
|
Correction to the CSHCN Services Program Provider Manual for Expendable Medical Supplies
|
|
Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) |
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
|
Update to CSHCN Services Program Provider Manual for Hospice Services |
|
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
|
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
|
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
|
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
|
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin 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 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
|
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
|
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
January 2019 CSHCN Release Notes |
|
Chapter |
Related Articles and Notes |
Revised “abuse” as “use” in subsection 3.1.5, “CSHCN Services Program Services and Supplies Limitations and Exclusions.” |
|
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.” |
Updated claims filing deadline calendar links in subsection 7.3, “Claims appeal,” and subsection 7.6, “Authorization and Filing Deadline Calendars.” |
|
Updated “Medicaid-enrolled” to “CSHCN Services Program-enrolled” in subsection 9.4.1, “Nonemergency Prior Authorizations.” |
|
Portability Permits No Longer Required for Dentists with Anesthesia or Sedation Permits Effective January 1, 2019 |
|
Procedure Code T4528 with Modifier U1 No Longer a Benefit January 1, 2019 |
|
Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) |
Update to CSHCN Services Program Provider Manual for Preventive Care Medical Checkups |
Revised ECI language regarding referrals in subsection 20.2.2, “Abnormal Hearing Screens.” |
|
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.” |