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Update to CSHCN Services Program Provider Manual

Last updated on 10/25/2019

Beginning November 15, 2019 TMHP will make updates to the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, regarding procedure code benefits and limitations for hearing, vision, and respiratory equipment and supplies services.

Limitation Update for Procedure Codes 99211 and 99212

TMHP will update the CSHCN Services Program Provider Manual, Hearing Services, section 20.2.3.5, “Limitations.” The following statement will be added:

Procedure codes 99211 and 99212 will be denied when billed for the same date of service by the same provider as procedure code 92592 or 92593.

Invalid Procedure Code E1340

TMHP will update the CSHCN Services Program Provider Manual, Respiratory Equipment and Supplies, section 36.2, “Benefits, Limitations, and Authorization Requirements.” The following statement will be removed:

Providers must use procedure code E1340 when requesting authorization and submitting claims for repairs.

Limitation Update for Procedure Codes 92071 and 92072

TMHP will update the CSHCN Services Program Provider Manual, Vision Services, section 40.2.1.4.1, “Contact Fitting for Corneal Bandage Lens.” The following statement will be removed:

Only one procedure code, 92071 or 92072, may be reimbursed per day, per provider.

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