The following tables show the section and handbooks that were changed in the Texas Medicaid Provider Procedures Manual in 2019. The changes are listed in reverse chronological order (newest first).
For changes made in 2018, see the 2018 Release Notes.
December 2019 Release Notes |
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Handbook |
Related Articles and Notes |
Notes: |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Notes: In section 3.3.9.3, “Provider and Supervision Requirements,” updated and replaced State Board of Examiners for Speech- Language Pathology and Audiology to reflect the correct organization name of Texas Department of Licensing and Regulation (TDLR). |
Related Articles: Update to TMPPM for Clinician-Administered Drugs Hematopoietic Injection Limitation Age Limitation to Change for Mepolizumab Effective December 1, 2019 Update to ‘Onasemnogene Abeparvovec-xioi (Zolgensma) Criteria Effective October 1, 2019, for Texas Medicaid’ |
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Related Articles:
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Related Articles: Notes: Added clarifying statement regarding age limitations to subsection, 2.2.17 “Nutritional (Enteral) Products, Supplies, and Equipment.” |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Notes: In section 6.1, “Provider Enrollment,” updated and replaced Texas Midwifery Board to reflect the correct organization name of Texas Department of Licensing and Regulation (TDLR). Edits made to statement in section 9.2.2.1, “Teaching Physician Prerequisites,” to clarify supervision requirements for teaching physicians in reference to the Graduate Medical Education (GME) program. |
Notes: |
November 2019 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Update to Timeframe Requirements for Provider Maintenance Files |
Revised language regarding private health insurance in section 4.7, “Healthy Texas Women (HTW) Program.” |
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Update Regarding Attending Provider NPI Requirements for Outpatient Claim Submissions Services Rendered by a Substitute Dentist May Be Billed to TMHP Utilizing Modifier U5, Effective Jan. 1, 2018 Updated subsection 6.7.4, “ADA Dental Claim Form Instruction Table” to align with current instructions. Replaced Coordination of Benefits Contractor (COBC) references with “Benefit Coordination and Recovery Center (BCRC)” to align with the new entity name. Corrected the claims filing deadline date for Thanksgiving and the day after Thanksgiving in subsection 6.1.4, “Claims Filing Deadlines.” |
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Removed Medicare language from section 8.4, “Non-TPR Sources.” |
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2019 ICD-10 Special Bulletin No.16 Medication Assisted Treatment Benefits to Change for Texas Medicaid November 1, 2019 |
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Children’s Services Handbook: THSteps Dental services (Section 4) |
Clarification of Dental Exception-to-Periodicity Modifiers for Texas Health Steps Dental Services Effective November 1, 2019 |
Third Quarter 2019 HCPCS Updates for Texas Medicaid Esketamine (Spravato) to Become a Benefit of Texas Medicaid Effective October 1, 2019 |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Updated subsection 2.1.2.1, “Proof of Continuation,” to add Provider Information Management System (PIMS) language to submission information for surety bonds. 2019 ICD-10 Special Bulletin No. 16 |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Removed IUD LARC language from subsection 2.2.5.2.1, “Long Acting Reversible Contraception: Intrauterine Devices.” |
Removed language regarding addresses on neonatal claim submissions in, subsection 3.7.3.7, “Other Requirements.” 2019 ICD-10 Special Bulletin No. 16 |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Revised the title of Section 9.2.5.2.3, “Prior Authorization for Collagen Skin Tests” to “Prior Authorization,” as the section contains information regarding both allergy testing and collagen skin tests. 2019 ICD-10 Special Bulletin No. 16 Benefit Changes for Clubfoot Casting Services Effective October 1, 2019 Third Quarter 2019 HCPCS Updates for Texas Medicaid |
Updated subsection 3.1.1, “Enrollment Criteria for Mammography Providers,” to add Provider Information Management System (PIMS) to the submission process for mammography certifications. |
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Removed “calendar” from procedure code statement in subsection 2.2.3.7, “Limitations.” 2019 ICD-10 Special Bulletin No. 16 |
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Revised language regarding private health insurance in section 2.1, “Guidelines for HTW Providers.” |
August 2019 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Removed link in section 1.12, “Forms.” Meaningful user Attestation Instructions-Stage 1 form is no longer in use. |
Updated section 8.3, “TPR Sources,” to add Specialized Skills Training (SST) language regarding ECI. |
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Removed acronym Global Assessment of Functioning (GAF) from table in section D.1, “Acronym Dictionary.” |
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Updated the table in section 9.6, “Outpatient Treatment Services,” to add Diagnosis codes F10951, F1223, F1293 & F553. Added language regarding POS in section 4, “Outpatient Mental Health Services.” |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), and THSteps Dental services (Section 4) |
Replaced broken link in Section 3.1.1, “Random Moment Time Study (RMTS),” with valid link https://rad.hhs.texas.gov/time-study/time-study-independent-school-districts-isd. Updated language in sections 5.3.11.3, “Immunizations,” and 5.5.1, “Claims Information,” to clarify when diagnosis code Z23 should be applied to vaccines. Update to TMPPM Children’s Services Handbook for Dental General Anesthesia |
Moxetumomab pasudotox-tdfk (Lumoxiti) Procedure Code C9045 is a Benefit of Texas Medicaid Effective August 1, 2019 Second Quarter 2019 HCPCS Updates for Texas Medicaid |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Mobility Aid Benefits to Change for Texas Medicaid August 1, 2019 |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Removed section 6.11, “Abortions” from handbook and moved G7 Modifier language and section 6.11.1, “Services Related to Abortion Procedures” to section 4.1.6, “Abortions.” |
Removed AXIS language in subsection 3.4.5, “Medicaid Clinical Criteria for Inpatient Psychiatric Care for Clients.” |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Update to TMPPM for Evoked Potential Testing Updated language in sections 9.2.37, “Immunizations for Clients Who Are 21 Years of Age and Older,” to clarify when diagnosis code Z23 should be applied to vaccines. Second Quarter 2019 HCPCS Updates for Texas Medicaid |
Telehealth Services Benefit Policy Updated Effective August 1, 2019 |
June 2019 Release Notes |
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Handbook |
Related Articles and Notes |
Removed procedure code H2035 in subsection 9.11.1, “Withdrawal Management Services” to align with policy. Removed language in subsection 9.11.2, “MAT Services” to align with policy. |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), Appendix B: Immunizations, and Appendix F: THSteps Quick Reference Guide |
In section 5.3.11.3, “Immunizations” added missing word “second” to the vaccine administration statement that addresses administration with counseling and administration without counseling in order to align with policy statement in the Vaccine and Toxoid Administration medical policy. Article published "HPV2 and HPV4 No Longer Available Through TVFC Program" |
Update to ‘First Quarter 2019 HCPCS Updates for Texas Medicaid’ |
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Updated language in subsection 3.6.1, “Admission Review.” |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Article published "HPV2 and HPV4 No Longer Available Through TVFC Program" In subsection 9.2.57.3.7, “Observation Services,” for clarity purposes removed “inpatient" - the procedure codes listed in the statement can be rendered in the inpatient and outpatient setting. Changes to the Sterilization Consent Form, Instructions, and Denial Letter Effective April 26, 2019 |
May 2019 Release notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Added note regarding additional physical address requirements in subsection 1.4.3, “Physical Address.” Updated language regarding EHR Incentive Program throughout Section 1.7 |
Added “NPI number of the referring and prescribing provider,” to the UB-04 instructions for blocks 78-79 in subsection, 6.6.3 “UB-04 CMS-1450 Instructions Table.” |
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Added statement regarding automatic eligibility in subsection 5.2.3.2, “Eligibility and Service Determinations for Clients Who are 21 Years of Age and Older.” Added new section 4.6, “Court-Ordered Services.” |
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Updated Prior Authorization Requirements for Chimeric Antigen Receptor (CAR) T-cell Therapy |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Added a note regarding handwritten alterations on invoices in subsection 2.2.2, “Durable Medical Equipment (DME) and Supplies.” Update to Maximum Limitations for Incontinence Procedure Codes A4396 and A4399 |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Smoking and Tobacco Use Cessation Counseling Benefits to Change for Texas Medicaid on May 1, 2019 |
Revised language regarding court-ordered services throughout section 3. |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Smoking and Tobacco Use Cessation Counseling Benefits to Change for Texas Medicaid on May 1, 2019 Update to TMPPM for Cytopathology Studies and Therapeutic Apheresis |
April 2019 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Updated the Provider EVV Vendor Selection Form hyperlink in subsection 1.12, “Forms”. |
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), Appendix B: Immunizations, and : Appendix F: THSteps Quick Reference Guide |
HPV2 and HPV4 No Longer Available Through TVFC Program |
Additional Payable Diagnosis Code for Procedure Code J1300 Eculizumab Updated Prior Authorization Requirements for Chimeric Antigen Receptor (CAR) T-cell Therapy Updated prior authorization statements to include text “all of,” within section 27, “Ibalizumab-uiyk (Trogarzo).” Updated prior authorization statements to include text “all of,” within section 40, “Patisiran (Onpattro).” April 2019 Second Quarter NCCI Updates for Texas Medicaid |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
HPV2 and HPV4 No Longer Available Through TVFC Program Wound Care Procedure Codes Q4186 and Q4187 are Benefits Effective January 1, 2019 |
Vision and Hearing Handbook Updated to Clarify Hearing Aid Invoice Requirements |
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HPV2 and HPV4 No Longer Available Through TVFC Program |
March 2019 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Added claims language to subsection 6.4.2.8, “Attachment to Claims.” |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Added statement to section 2.2.2, “Documentation Requirements,” about the claims process involving MCO recoupments. Updated website link in section 3.6.1, “Cost Reporting,” with the following: https://rad.hhs.texas.gov/acute-care/school-health-and-related-services/shars-cost-report-information. |
Effective March 1, 2019, New Prior Authorization Criteria for Patisiran
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Added clarifying statement to subsection 6.2.4, “Facility Revenue Codes,” to make it clear that renal dialysis facilities should not submit a HCPCS/CPT code on the claim with a revenue code. |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Removed procedure code A9275 from subsection 2.2.11.3, “Glucose Testing Equipment and Other Supplies.” |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Added “refer to” for breast pump chart in Section 3, “Breastfeeding Support Services.” |
Added claims language to subsection 2.7.3.2, “Documentation Requirements.” Update to Texas Medicaid Provider Procedures Manual, Medicaid Managed Care Services |
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Overview of Telemonitoring Benefit Changes for Texas Medicaid |
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Updated “HHSC Family Planning Program Services Policy and Procedure Manual” links throughout handbook. Updated HTW website link in subsection “HTW Provider Enrollment.” |
February 2019 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Replaced “yourtexasbenefitcard.com” with “TexMedConnect” throughout handbook. |
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Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 5.1.1 “Prior Authorization Requests for Clients with Retroactive Eligibility.” |
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Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 6.1.4 “Claims Filing Deadlines.” |
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Reminder: Beginning December 17, 2018, Providers Can Submit Administrative Appeals Electronically |
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Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 8.2, “Verifying a Client’s TPR.” |
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2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Update to add “or both” to section 6.2, “Peer Specialist Requirements.” Removed the “x” from the table in subsection 5.1.4.5, “Certifications for Mental Health Rehabilitative Services.” Added new SUD forms/links to section 12, “Forms.” |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) and THSteps Dental services (Section 4) |
New Psychological Assessment Procedure Codes for SHARS Providers Effective January 1, 2019 HHSC to Decommission the YourTexasBenefitsCard.com Website on December 14, 2018 Update to Children’s Services Handbook to Remove Requirements about Timely Checkup Reports Update to Children’s Services Handbook Texas Health Steps Medical Checkups 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Updated website link in section 3.6.1, “Cost Reporting,” with the following: https://rad.hhs.texas.gov/acute-care/school-health-and-related-services/shars-cost-report-information In section 4.2.16, “Periodontal Services,” under the Nonsurgical Periodontal Services section of the table, removed procedure codes D1110, D1120, D1206, D1208, D1351, D1510, and D1520 from the relationship statements for procedure codes D4341, D4342, and D4355 to align with statements 79-81 in the Texas Health Steps (THSteps) Therapeutic Dental Services medical policy. |
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
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2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Update to Benefit Limitation for Procedure Codes 96160 and 96161 in the Clinics and Other Outpatient Facility Services Handbook Added procedure code 96116, as this code is payable to FQHCs and the code was not listed in the table. |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Correction to the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook for CGM Devices 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Correction to Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 2.3.2, “Eligibility Verification Resources.” |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin |
2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Updated language in subsection 2.1.1, “Clinical Laboratory Improvement Amendments (CLIA).” |
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2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 4.2, “Provider Responsibilities.” |
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2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 2.1, “Guidelines for HTW Providers.” |
January 2019 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Added new provider type State Supported Living Center (SSLC) to subsection 1.1.4 “Provider Enrollment Identification.” |
Updated claims filing deadline calendars/holiday calendar and links in subsection 6.1.4 “Claims Filing Deadlines,” and 6.1.6 “Filing Deadline Calendars.” |
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Volume 1: Appendix A: State, Federal, and TMHP Contact Information |
Revised “abuse” as “use” in section A.10, “TMHP Telephone and Fax Communication.” Home Health Services Prior Authorization Requests No Longer Accepted Over the Phone Effective November 1, 2013 |
Revised language and grammar throughout the chapter. |
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Revised “abuse” as “use” in subsection 2.2.1, “Emergency Ambulance Transport Services.” |
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Revised “abuse” as “use” in subsection 5.2.3.5.1, “Independent Living Services.” Peer Specialist Services to Become a Benefit of Texas Medicaid January 1, 2019 Revised “abuse” as “use” in section 7, “Screening, Brief Intervention, and Referral to Treatment (SBIRT).” Substance Use Disorder Benefits to Change for Texas Medicaid January 1, 2019 |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) and THSteps Dental services (Section 4) |
Revised “abuse” as “use” in subsection 5.3.11.1.3, “Mental Health Screening.” Portability Permits No Longer Required for Dentists with Anesthesia or Sedation Permits Effective January 1, 2019 Moved section 4.2.23, “Dental Therapy Under General Anesthesia” to the Mandatory Prior Authorization section to be combined with subsection 4.2.30.2, “General Anesthesia for Dental Treatment.” Added procedure codes D4341 and D4342 to Section 4.2.30, “Mandatory Prior Authorization.” |
Third Quarter 2018 HCPCS Updates for Texas Medicaid |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Procedure Code T4528 with Modifier U1 No Longer a Benefit January 1, 2019 |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook Updated to Clarify Delivery Modifier Requirement |
Revised “abuse” as “use” in subsection 3.4.5, “Medicaid Clinical Criteria for Inpatient Psychiatric Care for Clients.” |
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Added “STAR Kids” to section 1 “General Information.” |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Shingles Vaccine Procedure Code 90750 to Become a Benefit of Texas Medicaid January 1, 2019 |
Revised “abuse” as “use” in subsection 3.2.6, “Authorization Requirements for CT, CTA, MRI, FMRI, MRA, PET, and Cardiac Nuclear Imaging Services.” |
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Updated reimbursement rate for eyeglass frames in subsection 4.3.4 “No covered Services.” |