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2020 CSHCN Release Notes

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The following tables show the section and handbooks that were changed in the CSHCN Services Program Provider Manual. The changes are listed in reverse chronological order (newest first).

To see the changes made in 2019, see the 2019 Release Notes.

December 2020 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 2: Provider Enrollment and Responsibilities

Revised the order of "Waste, Abuse, and Fraud" to "Fraud, Waste and Abuse," to align with the HHSC website language.

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

Moved place of service codes 55 and 56 from Inpatient Hospital to Outpatient Hospital.

Chapter 20: Hearing Services

Removed language regarding separate enrollment for audiologists in section 20.1.1, "Non-Implantable Hearing Aid Devices and Services."

Chapter 27: Neurostimulators and Neuromuscular Stimulators

Update to CSHCN Program Provider Manual Neurostimulators and Neuromuscular Stimulators
Information posted October 16, 2020

Removed add-on procedure codes 61782 and 61783 from sections 27.2.1, "Dorsal Column Neurostimulation (DCN)," 27.2.2, "Intracranial Neurostimulation (ICN)," and 27.2.11, "Revision or Removal of Implantable Neurostimulators." Revised procedure code L8633 as L8683 in section 27.2.12, "Implantable Neurstimulators and Neuromuscular Stimulators." Added reimbursement statement, "The purchase of supplies for NMES/TENS may only be considered for reimbursement for clients with a purchased device and a claims history of a NMES/TENS procedure within the last 5 years," to section 27.2.12.2, "NMES and TENS Supplies."

Chapter 31: Physician

Reimbursement Rate Updates for Procedure Code J7169 for the CSHCN Services Program
Information posted November 17, 2020

Chapter 33: Prescribed Pediatric Extended Care Centers

Added benefit limitation statement, "Procedure code T2002 is not allowed without a PPECC service procedure code billed on the same day by the same provider," to section 33.6, "Reimbursement."

Chapter 36: Respiratory Equipment and Supplies

Added benefit limitation statement, "Procedure codes A4556 and A4557 for the CRM may be reimbursed for clients with a purchased monitor, procedure code E0618 or E0619, within the last 5 years."

 

November 2020 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 1: TMHP and HHSC Contact Information

Updated phone and fax numbers for regional offices throughout chapter.

Chapter 11: Blood Pressure Devices and Supplies

ICD-10 Special Bulletin, No. 18
Information posted October, 2020

Chapter 14: Dental

Benefit limitation language added for procedure codes D4283 and D4285 in the table of section 14.2.6.6, "Periodontics."

Benefit limitation language added to dental caries reimbursement statement in section 14.2.3.2, "Clinical Oral Evaluations."

Chapter 18: Expendable Medical Supplies

ICD-10 Special Bulletin, No. 18
Information posted October, 2020

Chapter 25: Laboratory Services

ICD-10 Special Bulletin, No. 18
Information posted October, 2020

Chapter 26: Medical Nutrition Services

ICD-10 Special Bulletin, No. 18
Information posted October, 2020

Chapter 31: Physician

ICD-10 Special Bulletin, No. 18
Information posted October, 2020

Update to TMPPM and CSHCN Services Program Provider Manual for Pediatric Pneumogram Limitation
Information posted September 11, 2020

Chapter 40: Vision Services

ICD-10 Special Bulletin, No. 18
Information posted October, 2020

 

October 2020 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 10: Augmentative Communication Devices (ACDs)

Removed "Access device when necessary," and "Mounting device when necessary," from the bulleted list in section 10.2 to align with medical policy.

Chapter 14: Dental

CSHCN Dental Therapeutic Services Benefit Changes, Effective September 1, 2020
Information posted August 14, 2020

Broken link to First Dental Home webpage replaced with updated link.

Chapter 17: Durable Medical Equipment (DME)

Wheelchair Seating Evaluation Form Guidelines to be Updated for the CSHCN Services program October 1, 2020
Information posted September 11, 2020

Chapter 31: Physician

Added procedure code J2505 and limitation to the table in Section 31.2.25.5, "Injection Procedure Codes."

Chapter 36: Respiratory Equipment and Supplies

Benefit Limitation Updated for Respiratory Equipment and Supplies Procedure Code A4216
Information posted August 14, 2020

September 2020 CSHCN Release Notes

Handbook

Related Articles and Notes

Introduction

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 1: TMHP and HHSC Contact Information

Updated broken link in section 1.1.4, "TMHP-CSHCN Services Program Automated Inquiry System (AIS)."

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 2: Provider Enrollment and Responsibilities

Updated broken links in sections 2.1.4, 2.1.5.5, and 2.3.

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 3: Client Benefits and Eligibility

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 4: Prior Authorizations and Authorizations

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 6: Remittance and Status (R&S) Reports

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 7: Appeals and Administrative Review

Removed retired AIS user guide and updated broken links.

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 8: Advanced Practice Registered Nurse (APRN[NP/CNS])

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 9: Ambulance

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 10: Augmentative Communication Devices (ACDs)

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 11: Blood Pressure Devices and Supplies

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 12: Certified Registered Nurse Anesthetist (CRNA)

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 13: Certified Respiratory Care Practitioner (CRCP)

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 14: Dental

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 15: Diabetic Equipment and Supplies

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 16: Diagnostic Radiology Services

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 17: Durable Medical Equipment (DME)

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Update to ‘DME Modification Requirements Clarified for the CSHCN Services Program Effective August 1, 2020’
Information posted July 31, 2020

Chapter 18: Expendable Medical Supplies

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 20: Hearing Services

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 21: Home Health Services

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 22: Home Health (Skilled Nursing) Care

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 23: Hospice

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 24: Hospital

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 25: Laboratory Services

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 26: Medical Nutrition Services

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 27: Neurostimulators and Neuromuscular Stimulators

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 28: Orthotic and Prosthetic Devices

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 29: Outpatient Behavioral Health

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 30: Physical Medicine and Rehabilitation

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 31: Physician

Update to ‘Single-Dose Vial Unused Portion Reimbursement Policy for Clinician-Administered Drugs’
Information posted August 10, 2020

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 32: Physician Assistant (PA)

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 34: Radiation Therapy Services

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 35: Renal Dialysis

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 36: Respiratory Equipment and Supplies

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 37: Speech-Language Pathology (SLP) Services

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 38: Telecommunication Services

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 39: Transportation of Deceased Clients

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 40: Vision Services

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

Chapter 41: TMHP Electronic Data Interchange (EDI)

New Look and Features for the TMHP Website Available September 14, 2020
Information posted July 31, 2020

 

August 2020 Release Notes

Chapter

Related Articles and Notes

Chapter 16: Diagnostic Radiology Services
(posted August 14, 2020)

Related Articles:
Updates to the CSHCN Services Program Provider Manual Effective August 1, 2020
Information posted July 3, 2020

Chapter 20: Hearing Services
(posted August 14, 2020)

Related Articles:
Updates to the CSHCN Services Program Provider Manual Effective August 1, 2020
Information posted July 3, 2020

Chapter 25: Laboratory Services
(posted August 14, 2020)

Related Articles:
Updates to the CSHCN Services Program Provider Manual Effective August 1, 2020
Information posted July 3, 2020

Chapter 31: Physician
(posted August 14, 2020)

Related Articles:
Updates to the CSHCN Services Program Provider Manual Effective August 1, 2020
Information posted July 3, 2020

Single-Dose Vial Unused Portion Reimbursement Policy for Clinician-Administered Drugs
Information posted June 19, 2020

Second Quarter 2020 HCPCS Updates for the CSHCN Services Program
Information posted July 2, 2020

Chapter 34: Radiation Therapy Services
(posted August 14, 2020)

Related Articles:
Updates to the CSHCN Services Program Provider Manual Effective August 1, 2020
Information posted July 3, 2020

Chapter 38: Telecommunication Services
(posted August 14, 2020)

Related Articles:
Updates to the CSHCN Services Program Provider Manual Effective August 1, 2020
Information posted July 3, 2020

July 2020  Release Notes

Chapter

Related Articles and Notes

Chapter 13: Certified Respiratory Care Practitioner (CRCP)
(posted July 15, 2020)

Related Articles:
Benefit Limitation Updated for Respiratory Care Procedure Code 99503
Information posted May 15, 2020

June 2020 Release Notes

Chapter

Related Articles and Notes

Chapter 2: Provider Enrollment and Responsibilities
(posted June 15, 2020)

Related Articles:
TMHP Approved Vendor for Credit Balance and Recovery
Information posted April 3, 2020

Chapter 31: Physician
(posted June 15, 2020)

Related Articles:
Ravulizumab-cwvz (Ultomiris) Procedure Code J1303 to be a Benefit of the CSHCN Services Program
Information posted May 29, 2020

 

May 2020 Release Notes

Chapter

Related Articles and Notes

Chapter 1: TMHP and HHSC Contact Information
(posted May 15, 2020)

Notes:
Updated broken link in Subsection 1.1.4, "TMHP-CSHCN Services Program Automated Inquiry System (AIS)," to direct providers to the correct AMA website.

Chapter 4: Prior Authorizations and Authorizations
(posted May 15, 2020)

Notes:
Updated Authorization and Filing Deadline Calendars in Section 4.1, "General Information."

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement
(posted May 15, 2020)

Notes:
Updated broken link in Subsection 5.6.2.1, "Healthcare Common Procedure Coding System (HCPCS)," to direct providers to the correct AMA website.

Updated Filing Deadline Calendars in Sections 5.1.8, "Claims Filing Deadlines," and 5.5, "Correction and Resubmission (Appeal) Time Limits."

Chapter 7: Appeals and Administrative Review
(posted May 15, 2020)

Notes:
Updated broken link in Subsection 7.3.7, "National Correct Coding Initiative (NCCI) Claims Appeals," to direct providers to the correct CMS NCCI web page.

Updated Authorization and Filing Deadline Calendars in Sections 7.3, "Claim Appeals," and 7.6, "Authorization and Filing Deadline Calendars."

Chapter 14: Dental
(posted May 15, 2020)

Notes:
Updated broken link in Section 14.3, "Claims Information," to direct providers to the correct CMS NCCI web page.

Chapter 17: Durable Medical Equipment (DME)
(posted May 15, 2020)

Notes:
Updated broken form link in Subsection 17.3.3.1, "Breast Prosthesis Prior Authorization Requirements," to direct providers to the correct form.

Chapter 24: Hospital
(posted May 15, 2020)

Notes:
Updated the word "working" to "business" in subsection 24.3.1.2, "Emergency Inpatient Hospital Admissions."

Chapter 25: Laboratory Services
(posted May 15, 2020)

Related Articles:
Limitation for Specimen Validity Testing Procedure Codes for the CSHCN Services Program
Information posted March 27, 2020

New Quantity Limitation for Procedure Code 87798
Information posted April 3, 2020

Chapter 26: Medical Nutrition Services
(posted May 15, 2020)

Notes:
Updated broken hyperlink in Section 26.6.3, "Claims Information," to direct providers to the appropriate CMS NCCI web page.

Chapter 31: Physician
(posted May 15, 2020)

Updates to TMPPM and CSHCN Services Program Provider Manual for Genetic Services Reimbursement Criteria for Procedure Codes 99254 and 99255
Information posted March 27, 2020

CSHCN Physician Evaluation and Management Office and Outpatient Services Limitation Language Added
Information posted March 27, 2020

 

April 2020 Release Notes

Chapter

Related Articles and Notes

Chapter 24: Hospital
(posted April 15, 2020)

Added statement, "procedure code Q4081 is limited to three injections per calendar week (Sunday through Saturday)," to subsection 24.3.7.1, "Exceptions."

Chapter 31: Physician
(posted April 15, 2020)

Reimbursement Rate Updates for Some HCPCS Procedure Codes Will Implement for the CSHCN Services Program
Information posted February 24, 2020

Developmental Screening and Testing Benefit Limitation Language Updated for the CSHCN Services Program
Information posted March 13, 2020

Chapter 35: Renal Dialysis
(posted April 15, 2020)

Added statement, "procedure code Q4081 is limited to three injections per calendar week (Sunday through Saturday)," to subsection 35.3.5, "Unscheduled or Emergency Dialysis in a Non-Certified ESRD Facility."

 

March 2020 Release Notes

Chapter

Related Articles and Notes

Chapter 2: Provider Enrollment and Responsibilities
(posted March 13, 2020)

Removed PEP option for Hospice and Medical Food providers.

Chapter 17: Durable Medical Equipment (DME)
(posted March 13, 2020)

Language update regarding wheelchair power elevating leg lifts and wheelchair power seat evaluation system.

Chapter 25: Laboratory Services
(posted March 13, 2020)

Removed invalid procedure code 88235.

 

February 2020 Release Notes

Chapter

Related Articles and Notes

Chapter 11: Blood Pressure Devices and Supplies
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 14: Dental
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 15: Diabetic Equipment and Supplies
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 16: Diagnostic Radiology Services
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 17: Durable Medical Equipment (DME)
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 25: Laboratory Services
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 26: Medical Nutrition Services
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 28: Orthotic and Prosthetic Devices
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 31: Physician
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Related Articles:
Clarification Language for After-Hours Services Limitation Effective February 1, 2020
Information posted December 13, 2019

Chapter 38: Telecommunication Services
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

Chapter 40: Vision Services
(posted February 14, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17

 

January 2020 Release Notes

Chapter

Related Articles and Notes

Chapter 4: Prior Authorizations and Authorizations
(posted January 15, 2020)

Added subsection 4.4.2, “Closing a Prior Authorization.”

Chapter 31: Physician
(posted January 15, 2020)

Updated ImmTrac term as ImmTrac2 in subsection 31.2.24.2.1, “DSHS.”