|
| Update to “Stem Cell Transplants Benefits to Change for the CSHCN Services Program”
Information posted February 5, 2010: This is an update to the article published on the TMHP website at www.tmhp.com, on January 22, 2010, titled, “Stem Cell Transplants Benefits to Change for the CSHCN Services Program.” Click on the title to view the details. | | Prior Authorization Requirements to Change for Some Unlisted Procedure Codes Effective April 1, 2010
Information posted February 5, 2010: Effective for dates of service on or after April 1, 2010, prior authorization requirements will change for some unlisted procedure codes. Click on the title to view the details. | | ACIP Recommended Vaccines that are Not a Benefit
Information posted February 5, 2010:The Advisory Committee on Immunization Practices (ACIP) recommendations for adults includes vaccines that are not a benefit of Texas Medicaid. Texas Medicaid will not reimburse those vaccines that are not a benefit, even if recommended by ACIP. The following procedure codes are not a benefit of Texas Medicaid for clients of any age: 90581, 90650, 90736, and 90738. The following procedure codes are not a benefit of Texas Medicaid for clients who are 21 years of age or older: 90716, 90734, and 90660. Providers may be reimbursed only for the administration fee for procedure code 90663. Procedure code 90649 is not a benefit of Texas Medicaid for male clients.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Medicaid Reimbursement for Medicare and MAP secondary claims
Information posted February 5, 2010: Reminder: Texas Medicaid reimburses certain claims for dual-eligible clients enrolled in Medicare or Medicare Advantage Plans (MAP).Click on the title to view the details.
Article:
| | Correction to “Benefit Update for Botulinum Toxin Type A (Botox)”
Information posted February 5, 2010: This is an update to an article that first appeared on the January 1, 2010, Remittance and Status (R&S) Report, and to a web article that published on this website on December 18, 2009 titled “Benefit Update for Botulinum Toxin Type A (Botox)”. The type of botulinum listed in the original article was incorrect. Effective for dates of service on or after February 1, 2010, benefit criteria for Botulinum Toxin Type B (Myobloc Type B) will change for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the complete, corrected article. | | Claim Forms No Longer Needed with Paper Appeals
Information posted February 5, 2009: Effective immediately, claim appeal requests submitted on paper no longer require a completed claim form to be submitted with an appeal. The provider must clearly document on the Remittance and Status (R&S) Report what information is being appealed and must identify the claim being appealed. Click on the title to view the details. | | FQHC and RHC Providers Claims For PCCM Clients Require Referring Provider Effective April 1, 2010
Information posted February 5, 2010: Effective April 1, 2010, Federally Qualified Health Center (FQHC) and rural health clinic (RHC) providers must submit the referring provider’s National Provider Identifier (NPI) on claims for outpatient hospital or professional services that are provided to a PCCM client for whom they are not the primary care provider. If the referring provider’s NPI is not submitted on a claim for outpatient hospital or professional services that were provided to a PCCM client for whom they were not the primary care provider, the claim will be denied. Click on the title to view the details. | | PCCM Primary Care Providers Medical Records Are Routinely Audited by TMHP
Information posted February 5, 2010: Reminder: Medical records are subject to routine audits by Primary Care Case Management (PCCM) staff to ensure quality and continuity of care. In addition, primary care providers performing Texas Health Steps (THSteps) medical checkups must document all components of the checkup. Click on the title to view the details. | | Therapeutic Radiopharmaceutical Benefits to Change for Texas Medicaid
Information posted February 5, 2010: Effective for dates of service on or after April 1, 2010, therapeutic radiopharmaceutical benefits will change for Texas Medicaid. Click on the title to view the details. | | OFL Updated for Some Radiology Procedure Codes
Information posted February 5, 2010: TMHP has identified an issue that impacts the Online-Fee Look-Up (OFL) and the static fee schedules and some radiology procedure codes. Effective January 15, 2010, the OFL has been updated and the missing procedure codes can now be accessed. Click on the title to view a table of the affected codes. | | Correction to “Reimbursement Rates for Some Radiopharmaceutical Services Procedure Codes to Change”
Information posted February 5, 2010: This is a correction to a web article that was posted on this website on January 15, 2010, titled “Reimbursement Rates for Some Radiopharmaceutical Services Procedure Codes to Change.” The article listed an incorrect effective date for all procedure code rate changes. The article also incorrectly listed discontinued procedure code A9605 as a reimbursable procedure code. Click on the title to view the complete, corrected article.
| | Update to “Reimbursement Rates for Some Diagnostic Radiology Services Procedure Codes..”
Information posted February 5, 2010: This is an update to an article that was posted on this website on January 15, 2010. The article incorrectly indicated that effective February 19, 2010, for dates of service on or after January 1, 2010, reimbursement rates would change for some diagnostic radiology services procedure codes. The updated information is that reimbursement rates for some diagnostic radiology services procedure codes were effective January 1, 2010, and others will become effective on March 1, 2010. Click on the title to view the reimbursement rates table.
| | Update to “Reimbursement Rates for Some Musculoskeletal System Surgery Services Procedure Codes..."
Information posted February 5, 2010: This is an update to an article that was posted on this website on January 15, 2010. The article incorrectly indicated that effective February 19, 2010, for dates of service on or after January 1, 2010, reimbursement rates would change for some musculoskeletal services procedure codes. The updated information is that reimbursement rates for some musculoskeletal system services procedure codes were effective January 1, 2010, and others will become effective on March 1, 2010. Click on the title to view the reimbursement rates table.
| | Update to “Reimbursement Rates for Some Nuclear Medicine Services Procedure Codes...”
Information posted February 5, 2010: This is an update to an article that was posted on this website on January 15, 2010. The article incorrectly indicated that effective February 19, 2010, for dates of service on or after January 1, 2010, reimbursement rates would change for some nuclear medicine services procedure codes. The updated information is that reimbursement rates for some nuclear medicine services procedure codes were effective January 1, 2010, and others will become effective on March 1, 2010. Click on the title to view the reimbursement rates table.
| | Update to “Reimbursement Rates for Some Respiratory System Surgery Services Procedure Codes.."
Information posted February 5, 2010: This is an update to an article that was posted on this website on January 15, 2010. The article incorrectly indicated that effective February 19, 2010, for dates of service on or after January 1, 2010, reimbursement rates would change for some respiratory system surgery services procedure codes. The updated information is that reimbursement rates for some respiratory system surgery services procedure codes were effective January 1, 2010, and others will become effective on March 1, 2010 or April 1, 2010. Click on the title to view the updated rates.
| | New Banner Messages Are Available
Information posted February 5, 2010: Banner messages containing important informational updates regarding the Medicaid, Managed Care, Family Planning, and CSHCN Services Programs appear on the providers' Remittance and Status (R&S) reports each week. Click on the title to view this week's banner messages. | | 2009 HCPCS Second and Third Quarter New Benefits for Some Medical and DME Procedure Codes
Information posted January 29, 2010: Effective for dates of service on or after January 1, 2010, procedure codes C9250, C9360, C9361, and C9362, from the second and third quarter 2009 Healthcare Common Procedure Coding System (HCPCS) updates are benefits of Texas Medicaid. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details. | | 2010 Claims Filing Deadline Calendar Now Available for Medicaid and CSHCN Services Program Providers
Information posted January 29, 2010: The 2010 claims filing deadline calendar is now available for Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program providers. Click on the title to view the calendar.
| | Billing for Influenza A and B Testing
Information posted January 29, 2010: Providers that test clients for influenza A and influenza B on the same date of service and use procedure code 87804 to bill for each test must submit two separate details on the claim submission. Modifier 91 must be added to the second test to indicate a repeated clinical laboratory test billed more than once per day. Although the different strains of influenza require different tests, each test is billed using the same procedure code, so the second test is considered a repeated test.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
| | Women’s Health Program (WHP) Providers and Performance of Elective Abortions
Information posted January 29, 2010: Effective September 1, 2005, Section 32.048(h), Human Resources Code, prohibits the payment of Women’s Health Program (WHP) funds to providers that perform elective abortions. Click on the title to view the details. | | Radiology Procedure Codes Being Reinstated for NP, CNS, PA, and Radiation Treatment Center Providers
Information posted January 29, 2010: Effective February 11, 2010, for dates of service on or after July 1, 2009, some radiology procedure codes will be updated for nurse practitioner (NP), clinical nurse specialist (CNS), physician assistant (PA), and radiation treatment center providers in the office, inpatient hospital, or outpatient hospital setting. Click on the title to view the details.
| | Correction to Radiation Therapy Information in TMPPM
Information posted January 29, 2010: This is a correction to the 2009 Texas Medicaid Provider Procedures Manual section 36.4.45, “Radiation Therapy,” on page 36-117. The section indicates some incorrect places of service. Click on the title to view the correct places of service.
| | Cardiac Nuclear Imaging Studies Prior Authorization Requirement
Information posted January 29, 2010: TMHP has identified an issue that impacts claims submitted with 2010 Healthcare Common Procedure Coding System (HCPCS) cardiac nuclear imaging studies procedure codes 78451, 78452, 78453, and 78454 and dates of service from January 1, 2010, through January 31, 2010. Click on the title to view the details. | | New Circumcision Procedure Codes for the CSHCN Services Program
Information posted January 29, 2010: Effective for dates of service on or after March 1, 2010, the Children with Special Health Care Needs (CSHCN) Services Program will implement reimbursement rates for circumcision procedure codes 54150 and 54160. Click on the title to view the details. | | March-April 2010 Texas Medicaid Bulletin No. 228
Information posted January 27, 2010: The March-April 2010 Texas Medicaid Bulletin No. 228 is now available. Click the title to view the bulletin.
| | February 2010 Long Term Care Provider (LTC) Bulletin No. 41
Information posted January 27, 2010: The February 2010 Long Term Care (LTC) Provider Bulletin No. 41 is now available for download from the TMHP.com file library.
| | Postexposure Prophylaxis for Rabies to Be a Benefit of Texas Medicaid
Information posted January 22, 2010: Effective for dates of service on or after February 1, 2010, postexposure prophylaxis for rabies (procedure codes 90375, 90376, and 90675) will be a benefit of Texas Medicaid. Click on the title to view the details. | | Reminder: New PCCM Inpatient/Outpatient Authorization Form Required Effective March 1, 2010
Information posted January 22, 2010: Effective for dates of service on or after March 1, 2010, only the updated Primary Care Case Management (PCCM) Inpatient/Outpatient Authorization Form will be accepted, and all authorization requests received using the previous version of the form will not be processed and will be returned to providers. Click on the title to view the details. | | Stem Cell Transplants Benefits to Change for the CSHCN Services Program
Information posted January 22, 2010: Effective for dates of service on or after February 1, 2010, benefits will change for the Children with Special Health Care Needs (CSHCN) Services Program stem cell transplant services. Click on the title to view the details. | | Reimbursement Rates Change for Some Surgery Services Procedure Codes
Information posted January 22, 2010: Effective January 22, 2010, for dates of services on or after June 1, 2008, the reimbursement rates for the following surgery services procedure codes will change for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program: 11055, 11056, 11057, 11719, and G0127. Affected claims with dates of service on or after June 1, 2008, will be reprocessed, and payments will be adjusted accordingly. No action on the provider is required. Click on the title to view the details. | | Update to “2009 HCPCS 1Q and 2Q New Benefits for Some Medical Procedure Codes
Information posted January 22, 2010: This is an update to an article that was published on this website on December 11, 2009, titled “2009 HCPCS First and Second Quarter New Benefits for Some Medical Procedure Codes.” The article did not list all of the diagnosis restrictions for procedure code C9249. Click on the title to view the complete, corrected article. | | CSHCN Provider Bulletin No. 73
Information Posted January 22, 2010: The February 2010 CSHCN Provider Bulletin No. 73 is now available. Click the title to view the bulletin | | THSteps-CCP Blood Pressure Device Benefits to Change
Information posted January 15, 2010: Effective for dates of service on or after February 1, 2010, blood pressure device benefits will change for the Texas Health Step-Comprehensive Care Program (THSteps-CCP). Click on the title to view the details.
| | Texas Medicaid Sleep Studies Benefits to Change
Information posted January 15, 2010: Effective for dates of service on or after February 1, 2010, sleep study benefits will change for Texas Medicaid. Click on the title to view the details.
| | Renal Dialysis Services Criteria to Change for Texas Medicaid
Information posted January 15, 2010: Effective for dates of service on or after March 1, 2010, benefit criteria for renal dialysis services will change for Texas Medicaid. Click on the title to view the details. | | Reimbursement Rates for Some Respiratory System Surgery Services Procedure Codes to Change
Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some respiratory system surgery services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of provider is required. Click on the title to view the revised reimbursement rates.
| | Reimbursement Rates for Some Radiopharmaceutical Services Procedure Codes to Change
Information posted January 15, 2010: Effective February 19, 2010, for dates of service on or after January 1, 2010, reimbursement rates for some radiopharmaceutical services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details. | | Reimbursement Rates for Some Radiology Services Procedure Codes to Change
Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some radiology (portable X-ray) services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of provider is required. Click on the title to view the details.
| | Reimbursement Rates for Some Nuclear Medicine Services Procedure Codes to Change
Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some nuclear medicine services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of provider is required. Click on the title to view the details.
| | Reimbursement Rates for Some Musculoskeletal System Surgery Services Procedure Codes to Change
Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some musculoskeletal system surgery services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details.
| | Reimbursement Rates for Some Diagnostic Radiology Services Procedure Codes to Change
Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some diagnostic radiology services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details.
| | Reimbursement Rates for Sign Language Procedure Code to Change
Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for sign language or oral interpretive services procedure code T1013 with modifier U1 or UA will change for Texas Medicaid. The reimbursement rate for procedure code T1013 with modifier U1 will be $73.60. The reimbursement rate for procedure code T1013 with modifier UA will be $14.75. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Reimbursement Rates for Procedure Code H1010 to Change
Iformation posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for family planning services procedure code H1010 will change for Texas Medicaid. For clients who are birth through 20 years of age, the reimbursement rate for procedure code H1010 will be $11.46 (0.40 relative value unit [RVU], $28.640 conversion factor). For clients who are 21 years of age or older, the reimbursement rate will be $10.91 (0.40 relative value unit [RVU], $27.276 conversion factor). Affected claims for dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Reimbursement Rates for DME, Medical, and Surgery Procedure Code Changes for CSHCN Services Program
Information posted January 15, 2010: Effective for dates of services on or after February 1, 2010, reimbursement rates for some durable medical equipment (DME) services, medical services, surgery and assistant surgery services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
| | Postexposure Prophylaxis for Rabies to Be a Benefit of the CSHCN Services Program
Information posted January 15, 2010: Effective for dates of service on or after February 1, 2010, postexposure prophylaxis for rabies (procedure codes 90375, 90376, and 90675) will be a benefit of the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
|
|
|