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2019 TMPPM Release Notes

Last updated on 9/5/2020

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

Handbook

Related Articles and Notes

Behavioral Health and Case Management Services Handbook

Notes:
Updated URL links in section 3, “Case Management for Children and Pregnant Women.”

Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)

Notes:
In section 2.10.1, “Enrollment,” and 2.10.2, “Services, Benefits, and Limitations,” updated and replaced Texas State Board of Examiners of Dietitians to reflect the correct organization name of Texas Department of Licensing and Regulation (TDLR).

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).

Clinician-Administered Drugs (CAD) Handbook

Related Articles:
Eteplirsen to become a Benefit in the Home Setting Effective December 1, 2019
Information posted October 25, 2019

Update to TMPPM for Clinician-Administered Drugs Hematopoietic Injection Limitation
Information posted October 25, 2019

Age Limitation to Change for Mepolizumab Effective December 1, 2019
Information posted October 25, 2019

Update to ‘Onasemnogene Abeparvovec-xioi (Zolgensma) Criteria Effective October 1, 2019, for Texas Medicaid’
Information posted November 22, 2019

Clinics and Other Outpatient Facility Services Handbook

Related Articles:
Parsabiv Drug to be Included in Method I Composite Rate for Renal Dialysis Facilities
Information posted November 15, 2019

 

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Related Articles:
Clarification for Pediatric Hospital Bed Benefits
Information posted November 27, 2019

Notes:
Added introduction statement to table in subsection, 2.2.16.30, “Procedure Codes and Limitations for Mobility Aids.”

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 3.1, “Provider Enrollment,” added American Midwifery Certification Board (AMCB) to indicate the board that is responsible for the certification requirements of CNMs.

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. 

Radiology and Laboratory Services Handbook

Notes:
Added subsection regarding documentation requirements to section 2.2.8, “Drug Testing and Therapeutic Drug Assays.”

 

November 2019 TMPPM Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 1: Provider Enrollment and Responsibilities

Update to Timeframe Requirements for Provider Maintenance Files
Information posted October 24, 2019

Volume 1: Section 4: Client Eligibility

Revised language regarding private health insurance in section 4.7, “Healthy Texas Women (HTW) Program.”

Volume 1: Section 6: Claims Filing

Update Regarding Attending Provider NPI Requirements for Outpatient Claim Submissions
Information posted October 18, 2019

Services Rendered by a Substitute Dentist May Be Billed to TMHP Utilizing Modifier U5, Effective Jan. 1, 2018
Information posted November 17, 2017

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.”

Volume 1: Section 8: Third Party Liability (TPL)

Removed Medicare language from section 8.4, “Non-TPR Sources.”

Behavioral Health and Case Management Services Handbook

2019 ICD-10 Special Bulletin No.16
Information posted  September 30, 2019

Medication Assisted Treatment Benefits to Change for Texas Medicaid November 1, 2019
Information posted September 13, 2019

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
Information posted September 9, 2019

Clinician-Administered Drugs (CAD) Handbook

Third Quarter 2019 HCPCS Updates for Texas Medicaid
Information posted September 27, 2019

Esketamine (Spravato) to Become a Benefit of Texas Medicaid Effective October 1, 2019
Information posted October 11, 2019

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
Information posted September 30, 2019

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.”

Inpatient and Outpatient Hospital Services Handbook

Removed language regarding addresses on neonatal claim submissions in, subsection 3.7.3.7, “Other Requirements.”

2019 ICD-10 Special Bulletin No. 16
Information posted September 30, 2019

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
Information posted  September 30, 2019

Benefit Changes for Clubfoot Casting Services Effective October 1, 2019
Information posted September 20, 2019

Third Quarter 2019 HCPCS Updates for Texas Medicaid
Information posted September 27, 2019

Radiology and Laboratory Services Handbook

Updated subsection 3.1.1, “Enrollment Criteria for Mammography Providers,” to add Provider Information Management System (PIMS) to the submission process for mammography certifications.   

Vision and Hearing Services Handbook

Removed “calendar” from procedure code statement in subsection 2.2.3.7, “Limitations.”

2019 ICD-10 Special Bulletin No. 16
Information Posted September 30, 2019

Women’s Health Services Handbook

Revised language regarding private health insurance in section 2.1, “Guidelines for HTW Providers.”

 

October 2019 TMPPM Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 1: Provider Enrollment and Responsibilities

Updated 10 business day references to 30 days for changes related to ownership.

Added new subsection “Medicare Overpayment” with language regarding withholding Medicare overpayments.

Volume 1: Section 4: Client Eligibility

More Detailed View of Client Eligibility Information Coming to My Account on Client Portal
Information posted August 20, 2019

Volume 1: Section 5: Fee-for-Service Prior Authorizations

More Detailed View of Client Eligibility Information Coming to My Account on Client Portall
Information posted August 20, 2019

Volume 1: Section 6: Claims Filing

More Detailed View of Client Eligibility Information Coming to My Account on Client Portal
Information posted August 20, 2019

Volume 1: Section 8: Third Party Liability (TPL)

More Detailed View of Client Eligibility Information Coming to My Account on Client Portal
Information posted August 20, 2019

Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), THSteps Dental services (Section 4), and Appendix D: Texas Health Steps Statutory State Requirements

Updated the Code of Federal Regulations (CFR) rule 34 CFR §300.136(a) (1) in subsection 3.3.3.1, “Psychological Testing,” and changed to 42 CFR §440.60(a).

More Detailed View of Client Eligibility Information Coming to My Account on Client Portal
Information posted August 20, 2019

Updated language in appendix section 4.2.1.2, “Parental Accompaniment,” to be consistent with the legally-approved parental accompaniment language.

 

Clinician-Administered Drugs (CAD) Handbook

Onasemnogene Abeparvovec-xioi (Zolgensma) Criteria Effective October 1, 2019, for Texas Medicaid
Information posted September 6, 2019

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

More Detailed View of Client Eligibility Information Coming to My Account on Client Portal
Information posted August 20, 2019

Home Health Nursing and Private Duty Nursing Services Handbook

More Detailed View of Client Eligibility Information Coming to My Account on Client Portal
Information posted August 20, 2019

Inpatient and Outpatient Hospital Services Handbook

Lutetium Lu 177 dotatate (Lutathera) to become a Benefit of Texas Medicaid Effective June 1, 2019
Information posted September 6, 2019

Medicaid Managed Care Handbook

More Detailed View of Client Eligibility Information Coming to My Account on Client Portal
Information posted August 20, 2019

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Lutetium Lu 177 dotatate (Lutathera) to become a Benefit of Texas Medicaid Effective June 1, 2019
Information posted September 6, 2019

Vision and Hearing Services Handbook

More Detailed View of Client Eligibility Information Coming to My Account on Client Portal
Information posted August 20, 2019

Women’s Health Services Handbook

More Detailed View of Client Eligibility Information Coming to My Account on Client Portal
Information posted August 20, 2019

 

September 2019 TMPPM Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 1: Provider Enrollment and Responsibilities

Updated language for certain documentation that providers can update through the Provider Information Management System (PIMS).

Volume 1: Section 6: Claims Filing

Removed language regarding TPI requirements for Change of Ownership.

Updated Version of the American Dental Association Claim Form Now Available
Information posted August 30, 2019

Volume 1: Section 8: Third Party Liability (TPL)

Updated Version of the American Dental Association Claim Form Now Available
Information posted August 30, 2019

Ambulance Services Handbook

Correction to ‘Prior Authorization Requirements and Instructions Update for Ambulance Transportation Services’
Information posted June 21, 2019

Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), and Appendix A: THSteps Forms

Updated Version of the American Dental Association Claim Form Now Available
Information posted August 30, 2019

Clinician-Administered Drugs (CAD) Handbook

Clinician-Administered Drugs Procedure Code J0606 No Longer a Benefit Effective October 1, 2018
Information posted July 19, 2019

Added Payable Diagnosis Code and Age Restriction Change for Panhematin Procedure Code J1640
Information posted August 2, 2019

Second Quarter 2019 HCPCS Updates for Texas Medicaid
Information posted July 19, 2019

Clinics and Other Outpatient Facility Services Handbook

Update to TMPPM Clinics and Other Outpatient Facility Services Handbook
Information posted August 23, 2019

Clinician-Administered Drugs Procedure Code J0606 No Longer a Benefit Effective October 1, 2018
Information posted July 19, 2019

Updated Version of the American Dental Association Claim Form Now Available
Information posted August 30, 2019

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Removed typo “1” in section 2.2.16.24.1, “Prior Authorization.”

 

August 2019 TMPPM Release Notes

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.

Volume 1: Section 8: Third Party Liability (TPL)

Updated section 8.3, “TPR Sources,” to add Specialized Skills Training (SST) language regarding ECI.

Volume 1: Appendix D: Acronym Dictionary

Removed acronym Global Assessment of Functioning (GAF) from table in section D.1, “Acronym Dictionary.”

Behavioral Health and Case Management Services Handbook

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.”

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
Information posted July 12, 2019

Clinician-Administered Drugs (CAD) Handbook

Moxetumomab pasudotox-tdfk (Lumoxiti) Procedure Code C9045 is a Benefit of Texas Medicaid Effective August 1, 2019
Information posted June 14, 2019

Second Quarter 2019 HCPCS Updates for Texas Medicaid
Information posted July 19, 2019

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Mobility Aid Benefits to Change for Texas Medicaid August 1, 2019
Information posted July 8, 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.”

Inpatient and Outpatient Hospital Services Handbook

Removed AXIS language in subsection 3.4.5, “Medicaid Clinical Criteria for Inpatient Psychiatric Care for Clients.”

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Update to TMPPM for Evoked Potential Testing
Information posted July 26, 2019

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
Information posted July 19, 2019

Telecommunication Services Handbook

Telehealth Services Benefit Policy Updated Effective August 1, 2019
Information posted June 14, 2019

 

July 2019 TMPPM Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 6: Claims Filing

TMHP to Update National Place of Service Code Value 57
Information posted May 20, 2019

Deactivated NCCI MUE Limitations for Substance Use Disorder Treatment and Breast Pump Replacement Parts
Information posted May 31, 2019

Volume 1: Appendix A: State, Federal, and TMHP Contact Information

Updated subsection A.12.3 “Automated Inquiry System (AIS)” to remove language regarding AIS user guide.

Behavioral Health and Case Management Services Handbook

Delegated Psychological Services to Allow More Than One Modifier on the Same Date of Service Effective July 1, 2019
Information posted May 17, 2019

Deactivated NCCI MUE Limitations for Substance Use Disorder Treatment and Breast Pump Replacement Parts
Information posted May 31, 2019

Clinician-Administered Drugs (CAD) Handbook

Procedure Codes Q5108 and Q5110 Will Be Added to Colony Stimulating Factors Policy Effective July 1, 2019
Information posted May 17, 2019

Mogamulizumab-kpkc (Poteligeo) a Benefit of Texas Medicaid Effective March 1, 2019
Information posted May 23, 2019

Benefit Limitations for Epoetin Beta (Mircera)
Information posted April 24, 2019

Removed procedure code Q4081 from the CAD handbook section 6.1.4, “Nonspecific, Unlisted or Miscellaneous Procedure Codes,” as the procedure code is housed in the Clinics handbook - Renal Dialysis section.

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook

Deactivated NCCI MUE Limitations for Substance Use Disorder Treatment and Breast Pump Replacement Parts
Information posted May 31, 2019

Tobacco Use Cessation Services Provided in a Group Setting
Information posted May 17, 2019

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Tobacco Use Cessation Services Provided in a Group Setting
Information posted May 17, 2019

Radiology and Laboratory Services Handbook

Updated Limitation for Zika Virus Testing Effective July 1, 2019
Information posted May 17, 2019

 

June 2019 Release Notes

Handbook

Related Articles and Notes

Behavioral Health and Case Management Services Handbook

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.

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"
Information posted June 10, 2016

Clinician-Administered Drugs (CAD) Handbook

Update to ‘First Quarter 2019 HCPCS Updates for Texas Medicaid’
Information posted April 16, 2019

Inpatient and Outpatient Hospital Services Handbook

Updated language in subsection 3.6.1, “Admission Review.”

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Article published "HPV2 and HPV4 No Longer Available Through TVFC Program"
Information posted June 10, 2016

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
Information posted March 8, 2019

 

May 2019 Release notes

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

Volume 1: Section 6: Claims Filing

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.”

Behavioral Health and Case Management Services Handbook

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.”

Clinician-Administered Drugs (CAD) Handbook

Updated Prior Authorization Requirements for Chimeric Antigen Receptor (CAR) T-cell Therapy
Information posted March 29, 2019

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
Information posted April 12, 2019

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
Information posted March 19, 2019

Inpatient and Outpatient Hospital Services Handbook

Revised language regarding court-ordered services throughout section 3.

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
Information posted March 19, 2019

Update to TMPPM for Cytopathology Studies and Therapeutic Apheresis
Information posted April 26, 2019

 

April 2019 TMPPM Release Notes

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
Information posted June 10, 2016

Clinician-Administered Drugs (CAD) Handbook

Additional Payable Diagnosis Code for Procedure Code J1300 Eculizumab
Information posted January 18, 2019

Updated Prior Authorization Requirements for Chimeric Antigen Receptor (CAR) T-cell Therapy
Information posted March 29, 2019

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
Information posted March 12, 2019

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

HPV2 and HPV4 No Longer Available Through TVFC Program
Information posted June 10, 2016

Wound Care Procedure Codes Q4186 and Q4187 are Benefits Effective January 1, 2019
Information posted March 29, 2019

Vision and Hearing Services Handbook

Vision and Hearing Handbook Updated to Clarify Hearing Aid Invoice Requirements
Information posted March 15, 2019

Women’s Health Services Handbook

HPV2 and HPV4 No Longer Available Through TVFC Program
Information posted June 10, 2016

 

March 2019 TMPPM Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 6: Claims Filing

Added claims language to subsection 6.4.2.8, “Attachment to Claims.”

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.

Clinician-Administered Drugs (CAD) Handbook

Effective March 1, 2019, New Prior Authorization Criteria for Patisiran
Information posted February 1, 2019

 

Clinics and Other Outpatient Facility Services Handbook

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.

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.”

Medicaid Managed Care Handbook

Added claims language to subsection 2.7.3.2, “Documentation Requirements.”

Update to Texas Medicaid Provider Procedures Manual, Medicaid Managed Care Services
Information posted February 22, 2019

Telecommunication Services Handbook

Overview of Telemonitoring Benefit Changes for Texas Medicaid
Information posted February 26, 2019

Women’s Health Services Handbook

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

Handbook

Related Articles and Notes

Volume 1: Section 4: Client Eligibility

Replaced “yourtexasbenefitcard.com” with “TexMedConnect” throughout handbook.

Volume 1: Section 5: Fee-for-Service Prior Authorizations

Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 5.1.1 “Prior Authorization Requests for Clients with Retroactive Eligibility.”

Volume 1: Section 6: Claims Filing

Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 6.1.4 “Claims Filing Deadlines.”

Volume 1: Section 7: Appeals

Reminder: Beginning December 17, 2018, Providers Can Submit Administrative Appeals Electronically
Information posted November 27, 2018

Volume 1: Section 8: Third Party Liability (TPL)

Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 8.2, “Verifying a Client’s TPR.”

Behavioral Health and Case Management Services Handbook

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

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.”

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
Information posted December 21, 2018

HHSC to Decommission the YourTexasBenefitsCard.com Website on December 14, 2018
Information posted December 7, 2018

Update to Children’s Services Handbook to Remove Requirements about Timely Checkup Reports
Information posted January 28, 2019

Update to Children’s Services Handbook Texas Health Steps Medical Checkups
Information posted December 14, 2018

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

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.

Clinician-Administered Drugs (CAD) Handbook

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Clinics and Other Outpatient Facility Services Handbook

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Update to Benefit Limitation for Procedure Codes 96160 and 96161 in the Clinics and Other Outpatient Facility Services Handbook
Information to be posted January 25, 2019

Added procedure code 96116, as this code is payable to FQHCs and the code was not listed in the table.

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Correction to the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook for CGM Devices
Information posted December 14, 2018

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Correction to Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook
Information posted January 25, 2019

Medicaid Managed Care Handbook

Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 2.3.2, “Eligibility Verification Resources.”

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Radiology and Laboratory Services Handbook

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Updated language in subsection 2.1.1, “Clinical Laboratory Improvement Amendments (CLIA).”

Vision and Hearing Services Handbook

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 4.2, “Provider Responsibilities.”

Women’s Health Services Handbook

2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin
Information posted December 31, 2018

Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 2.1, “Guidelines for HTW Providers.”

 

January 2019 TMPPM Release Notes

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.”

Volume 1: Section 6: Claims Filing

Updated claims filing deadline calendars/holiday calendar and links in subsection 6.1.4 “Claims Filing Deadlines,” and 6.1.6 “Filing Deadline Calendars.”

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
Information posted September 13, 2013

Volume 1: Appendix B: Vendor Drug Program

Revised language and grammar throughout the chapter.

Ambulance Services Handbook

Revised “abuse” as “use” in subsection 2.2.1, “Emergency Ambulance Transport Services.”

Behavioral Health and Case Management Services Handbook

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
Information posted November 16, 2018

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
Information posted November 16, 2018

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
Information posted November 16, 2018

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.”

Clinician-Administered Drugs (CAD) Handbook

Third Quarter 2018 HCPCS Updates for Texas Medicaid
Information posted September 28, 2018

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Procedure Code T4528 with Modifier U1 No Longer a Benefit January 1, 2019
Information posted November 16, 2018

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook Updated to Clarify Delivery Modifier Requirement
Information posted December 14, 2018

Inpatient and Outpatient Hospital Services Handbook

Revised “abuse” as “use” in subsection 3.4.5, “Medicaid Clinical Criteria for Inpatient Psychiatric Care for Clients.”

Medicaid Managed Care Handbook

Added “STAR Kids” to section 1 “General Information.”

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Shingles Vaccine Procedure Code 90750 to Become a Benefit of Texas Medicaid January 1, 2019
Information posted November 16, 2018

Radiology and Laboratory Services Handbook

Revised “abuse” as “use” in subsection 3.2.6, “Authorization Requirements for CT, CTA, MRI, FMRI, MRA, PET, and Cardiac Nuclear Imaging Services.”

Vision and Hearing Services Handbook

Updated reimbursement rate for eyeglass frames in subsection 4.3.4 “No covered Services.”