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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

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Hearing Services Benefits to Change Effective November 1, 2018 for CSHCN Services Program

Last updated on 9/11/2020

Effective for dates of service on or after November 1, 2018, benefit and policy language will change for hearing services for the Children with Special Health Care Needs Services Program.

Abnormal Hearing Screening

Clients who are birth through 35 months of age with suspected or confirmed hearing loss must be referred to Early Childhood Intervention (ECI) as soon as possible, but no longer than seven days after identification, even if referred to an appropriate provider for further testing. The provider should obtain consent from the client’s responsible adult prior to making the referral to ECI. The client’s responsible adult may refuse to permit the referral.

Vestibular Evaluations

Hearing pathway tests such as audiometry, automated auditory brainstem response (A-ABR), and Electrocochleography (ECoG) can be used to identify an inner ear disorder.

Hearing Aid Trial Period

A trial period of up to 30 days is authorized by Texas Operations Code §402.401. The 30-day trial period, and any charged rental fee, must meet the Texas Department of Licensing and Regulation (TDLR) rule requirements in 16 TAC §112.140.

Hearing Evaluations

Hearing evaluations must be recommended by a physician based on examination of the client. An advanced practice registered nurse (APRN) or a physician assistant under physician supervision and delegation may also perform the client examination.

Ear Molds

The date of service for ear molds is the date the ear molds are dispensed to the client.

Disposable ear molds, procedure code V5265, are limited to four ear molds per ear, per 30 days, any provider.

Reimbursement

Comprehensive audiometry procedure codes 92553 and 92556 will not be reimbursed on the same day, by the same provider, for the same client. If both procedure codes are billed on the same date of service, by the same provider, for the same client, they will be denied with instructions to bill with the more comprehensive audiometry procedure code 92557.

Pure tone audiometry procedure codes 92551, 92552, and 92553 will be limited to one per day, same provider, same client.

The following audiometric testing procedure codes may be reimbursed for testing performed in both ears:

Procedure Codes	Type of Service
92558	Medical Services
92585 92587 92588	Total Component
92586	Laboratory

Procedure Codes

Type of Service

92558

Medical Services

92585

92587

92588

Total Component

92586

Laboratory

For testing that is only performed in one ear, providers must use modifier 52 with the above procedure codes.

The following procedure codes may be reimbursed for evaluative and therapeutic services and are limited to four services per rolling year:

Procedure Codes
92620	92621	92625

Providers must submit a prior authorization request with documentation of medical necessity for additional reimbursement of the procedure codes listed above.

The procedure codes in the following table show added and discontinued provider types:

Procedure Codes	Type of Service	Place of Service	Added Provider Types	Discontinued Provider Types
92540	Total Component	Office, Outpatient Hospital	Audiologist	N/A
92576	Laboratory	Office	Audiologist	N/A
92620	Medical Service	Office	Audiologist	Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Independent Lab, Nephrology providers
		Inpatient Hospital, Outpatient Hospital providers	Physician, Audiologist providers	Hospital Providers
		Laboratory	N/A	All Providers
92621	Medical Service	Office	Audiologist	Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Independent Lab, Nephrology providers
		Inpatient Hospital, Outpatient Hospital providers	Physician, Audiologist providers	Hospital Providers
		Laboratory	N/A	All Providers
92625	Medical Service	Office	Audiologist	Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Independent Lab, Nephrology providers
		Inpatient Hospital	Physician, Audiologist providers	Hospital providers
		Outpatient Hospital	Physician, Audiologist providers	N/A
		Laboratory	N/A	All Providers

Procedure code 92568 will no longer be diagnosis restricted.

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.