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Benefit Changes for Clubfoot Casting Services Effective October 1, 2019

Last updated on 9/20/2019

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective for dates of service on or after October 1, 2019, diagnosis and age restrictions will be updated for clubfoot casting services.

The following procedure codes will be limited to clients ages 3 and younger:

Procedure Code Type of Service
29540 Ambulatory Surgical Center
29750 Surgery

The following diagnosis codes may be reimbursed when submitted with procedure code 29450:

 
M21541 M21542 M21549 Q6600 Q6601 Q6602 Q6610
Q6611 Q6612 Q66211 Q66212 Q66219 Q66221 Q66222
Q66229 Q6630 Q6631 Q6632 Q6640 Q6641 Q6642
Q6651 Q6652 Q666 Q6670 Q6671 Q6672 Q6681
Q6682 Q6689 Q6690 Q6691 Q6692    

For more information, refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, And Physician Assistants Handbook, subsection 9.2.59.1, “Clubfoot Casting.”

For more information, call the TMHP Contact Center at 800-925-9126.