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2020 TMPPM Release Notes

Last updated on 8/28/2020

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

For changes that were made in 2019, see the 2019 Release Notes.

September 2020 Release Notes

Handbook

Related Articles and Notes

Appendix B: Vendor Drug Program
(Merged with new Outpatient Drug Services Handbook)

Notes:
Merged contents of the Vendor Drug Program handbook with the Clinician-Administered Drugs Handbook that has been renamed as Outpatient Drug Services Handbook.

Section 5: Fee-for-Service Prior Authorizations
(posted August 31, 2020)

Notes:
Updated eviCore websites and method of submissions for PA requests to eviCore throughout section 5.

Behavioral Health and Case Management Services Handbook
(posted August 31, 2020)

Notes:
Revised language throughout section 9 to align with medical policy.

Children’s Services Handbook: THSteps Dental services (Section 4)
(posted August 31, 2020)

Related Articles:
Texas Health Steps Therapeutic Dental Benefit Changes Effective September 1, 2020
Information posted July 17, 2020

Notes:
Removed section for implant services as these services are not a benefit of Medicaid.

Added new dental plan to table of Section 4.2.5, “Children's Medicaid Dental Plan Choices.”

Clinician-Administered Drugs (CAD) Handbook
(Merged with new Outpatient Drug Services Handbook)

Related Articles:
Prior Authorization Criteria for Luspatercept-aamt (Reblozyl) Effective September 1, 2020
Information posted July 17, 2020

Single-Dose Vial Unused Portion Reimbursement Policy for Clinician Administered Drugs
Information posted June 16, 2020

Botulinum Toxin Type A and B Benefits to Change for Texas Medicaid, Effective September 1, 2020
Information posted August 7, 2020

Second Quarter 2020 HCPCS Updates for Texas Medicaid
Information posted June 30, 2020

Reimbursement Rate Updates for Procedure Code J9358 Effective July 1, 2020
Information posted July 31, 2020

Benralizumab, Mepolizumab, and Reslizumab Benefits to Change for Texas Medicaid September 1, 2020
Information posted August 6, 2020

Notes:
Added relationship statement for the injection pegfilgrastim procedure code J2505 to section 7.19, "Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim)." Added vial dosage information to section 4, “Reimbursement.”

Merged contents of the Vendor Drug Program handbook with the Clinician-Administered Drugs Handbook. The CAD handbook was renamed as Outpatient Drug Services Handbook. Contents of CAD and VDP were reorganized. CAD injections table was removed and a section was created for each injection that currently was not in an existing section. Standard prior authorization language was moved from some sections and a general prior authorization section was created. Some tables were reformatted throughout the handbook.

Inpatient and Outpatient Hospital Services Handbook
(posted August 31, 2020)

Notes:
Removed invalid Radiology Prior Authorization Request Form from section 9, "Forms."

Added new subsection 3.7.1 with language regarding Inpatient claim submissions.

Medicaid Managed Care Handbook
(posted August 31, 2020)

Related Articles:
Update to TMPPM Medicaid Managed Care Handbook to Include HCBS-AMH as Carve-Out Services
Information posted July 6, 2020

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook
(posted August 31, 2020)

Related Articles:
Genetic Testing for Colorectal Cancer Prior Authorization Language Updated, Effective September 1, 2020
Information posted July 17, 2020

Outpatient Drug Handbook
(posted August 31, 2020)

Notes:
The Clinician-Administered Drugs (CAD) handbook has been renamed as the Outpatient Drug Services Handbook.

Radiology and Laboratory Services Handbook
(posted August 31, 2020)

Related Articles:
Genetic Testing for Colorectal Cancer Prior Authorization Language Updated, Effective September 1, 2020
nformation posted July 17, 2020

Notes:
Removed invalid Radiology Prior Authorization Request form and updated method of submissions for PA requests to eviCore.

August 2020 Release Notes  

Handbook

Related Articles and Notes

Section 5: Fee-for-Service Prior Authorizations
(posted July 31, 2020)

Notes:
Revised the contacts and fax number table in section 5.5.2.2 "TMHP Prior Authorization Requests by Fax.”

Section 6: Claims Filing
(posted July 31, 2020)

Notes:
Removed the note "Texas Medicaid does not pay for drug wastage" in section 6.3.4.3, "Drug Rebate Program.” Added note in subsection 6.2.5.3, "Interpretations," to clarify the use of modifier 26.

Section 8: Third Party Liability (TPL)
(posted July 31, 2020)

Notes:
Updated section 8.3.1, "Exceptions," to add Blind and Visually Impaired Services and Healthy Texas Women to the list of most common non-TPR sources.

Clinician-Administered Drugs (CAD) Handbook
(posted July 31, 2020)

 

Related Articles:
Single-Dose Vial Unused Portion Reimbursement Policy for Clinician-Administered Drugs
Information posted June 16, 2020

Second Quarter 2020 HCPCS Updates for Texas Medicaid
Information posted June 30, 2020

Antisense Oligonucleotide Benefits to Change for Texas Medicaid Effective August 1, 2020
Information posted July 31, 2020

Notes:
Added vial dosage information to section 4, “Reimbursement.”

Removed statement, "Texas Medicaid does not pay for any drug wastage from single-use or multi-use vials," in section 6.1.3, “Single and Multi-Use Vials.”

Added clarifying language to statement within the bulleted list in section 6.1.4, “Nonspecific, Unlisted, or Miscellaneous Procedure Codes.”

Revised procedure code J7288, as it should be listed as J2788 in the table of Section 32, “Immune Globulin.”

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook
(posted July 31, 2020)

Notes:
Revised language in section 4.18, "Obstetric Ultrasound" for procedure codes 76810, 76812, and 76814, as they must be billed by the same provider.

Medicaid Managed Care Handbook
(posted July 31, 2020)

Notes:
Corrected the zip code in section 2.10.1, “Medicaid Managed Care Complaints and Fair Hearings.”

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook
(posted July 31, 2020)

Related Articles:
Updates to the Texas Medicaid Provider Procedures Manual Effective August 1, 2020
Information posted July 3, 2020

Notes:
In the complex closure procedure codes table of Section 9.2.21, “Closure of Wounds,” removed extra digit from procedure code 131022, as it should be listed as 13102

Medical Transportation Program Handbook
(posted July 31, 2020)

Notes:
Replaced "Prior authorization number" with "MTP authorization number" in section 2.3, "Claims Filing for ITPs," to align with the H3017 form.

Vision and Hearing Services Handbook
(posted July 31, 2020)

 

Related Articles:
Updates to the Texas Medicaid Provider Procedures Manual Effective August 1, 2020
Information posted July 3, 2020

 

July 2020 Release Notes

Handbook

Related Articles and Notes

Appendix A: State, Federal, and TMHP Contact Information
(posted June 30, 2020)

Related Articles:
Update to TMPPM for the Term ImmTrac
Information posted June 5, 2020

Appendix D: Acronym Dictionary
(posted June 30, 2020)

Related Articles:
Update to TMPPM for the Term ImmTrac
Information posted June 5, 2020

Section 1: Provider Enrollment and Responsibilities
(posted June 30, 2020)

Related Articles:
Update to TMPPM for the Term ImmTrac
Information posted June 5, 2020

Notes:
Updated subsection 1.2.4, "Receiving Paper Checks" to add accounting address.

Section 6: Claims Filing
(posted June 30, 2020)

Related Articles:
Effective June 26, 2020, New Field to be Added to Remittance and Status Report
Information posted May 8, 2020

Section 8: Third Party Liability (TPL)
(posted June 30, 2020)

Notes:
Removed section regarding Claims Forwarded to Other Insurance Carriers.

Children’s Services Handbook
(posted June 30, 2020)

Related Articles:
Update to TMPPM for the Term ImmTrac (Updates made to Appendix B: Immunizations, Appendix F: THSteps Quick Reference Guide, and Medical Services (Sections 1-3 and 5-9)
Information posted June 5, 2020

Notes:
Updated broken link for the ImmTrac website in Section B.3.5.2, "Electronic Data Transfer (Import)."

Clinician-Administered Drugs (CAD) Handbook 
(posted June 30, 2020)

Related Articles:
Esketamine (Spravato) to Become a Benefit for Specialty Pharmacy Providers Effective July 1, 2020
Information posted June 5, 2020

Calaspargase Pegol-Mknl a Benefit for Texas Medicaid April 1, 2020
Information posted June 4, 2020

Prior Authorization Criteria for Crizanlizumab-tmca (Adakveo) Effective July 1, 2020
Information posted June 5, 2020

Prior Authorization Criteria for Brexanolone (Zulresso) Effective July 1, 2020
Information posted June 12, 2020

Inpatient and Outpatient Hospital Services Handbook 
(posted June 30, 2020)

Related Articles:
Reimbursement Criteria Updated for Brachytherapy and Therapeutic Radiopharmaceuticals Effective July 1, 2020
Information posted May 15, 2020

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook
(posted June 30, 2020)

Related Articles:
Update to TMPPM for the Term ImmTrac
Information posted June 5, 2020

Clarification to ‘Reimbursement Criteria Updated for Brachytherapy and Therapeutic Radiopharmaceuticals Effective July 1, 2020’
Information posted June 17, 2020

Notes:
Corrected misspelled word in the first sentence of the paragraph in Section 9.2.40.4, "Prior Authorization Requirements."

Radiology and Laboratory Services Handbook 
(posted June 30, 2020)

 

Related Articles:
Claims Filing for Medicare-Enrolled Speech-Language Pathologists, Effective June 1, 2020
Information posted April 17, 2020

Update to Texas Medicaid Provider Procedures Manual, Radiology and Laboratory Services Handbook
Information posted June 26, 2020

Telecommunication Services Handbook
(posted June 30, 2020)

Related Articles:
Claims Filing for Medicare-Enrolled Speech-Language Pathologists, Effective June 1, 2020
Information posted April 17, 2020

Vision and Hearing Services Handbook
(posted June 30, 2020)

Notes:
Replaced incorrect procedure code 9902 in section 4.3.5.10, "Ophthalmoscopy and Extended Ophthalmoscopy," with correct procedure code 92202

 

June 2020 Release Notes

Handbook

Related Articles and Notes

Section 1: Provider Enrollment and Responsibilities
(posted May 29, 2020)

Related Articles:
Beginning May 1, 2020, Medicare-Enrolled Speech-Language Pathologists May Apply to Enroll as Texas Medicaid Providers
Information posted March 13, 2020

Section 7: Appeals
(posted May 29, 2020)

Notes:
Removed auto-hyphenation in the appeals email address in subsection 7.3.1, "Administrative Claim Appeals."

Clinician-Administered Drugs (CAD) Handbook
(posted May 29, 2020)

Related Articles:
Benralizumab, Mepolizumab, and Omalizumab Benefits in the Home Setting
Information posted May 8, 2020

Additional Diagnosis Code Added for Eculizumab
Information posted April 29, 2020

Antisense Oligonucleotides (Eteplirsen and Nusinersen) Benefits to Change for Texas Medicaid
Information posted May 1, 2020

Update to “First Quarter 2020 HCPCS Updated for Texas Medicaid”
Information posted April 24, 2020

Notes:
Added diagnosis codes and place of service to the table of section 6.1.4, "Nonspecific, Unlisted or Miscellaneous Procedure Codes," for Ravilizumab procedure code J1303.

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook
(posted May 29, 2020)

Related Articles
Home Health DME and Supplies Exceptional Circumstances Provision for Medicaid Clients 21 Years of Age and Older
Information posted April 29, 2020

Notes:
Removed language from subsection 2.2.16.31 regarding feeder seats, floor sitters, corner chairs, and travel chairs not considered medically necessary devices.

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook
(posted May 29, 2020)

Related Articles:
Home Health DME and Supplies Exceptional Circumstances Provision for Medicaid Clients 21 Years of Age and Older
Information posted April 29, 2020

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook
(posted May 29, 2020)

Related Articles:
Home Health DME and Supplies Exceptional Circumstances Provision for Medicaid Clients 21 Years of Age and Older
Information posted April 29, 2020

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook
(posted May 29, 2020)

Related Articles:
Claims Filing for Medicare-Enrolled Speech-Language Pathologists, Effective June 1, 2020
Information posted April 17, 2020

Telecommunication Services Handbook
(posted May 29, 2020)

Related Articles:
Claims Filing for Medicare-Enrolled Speech-Language Pathologists, Effective June 1, 2020
Information posted April 17, 2020

Vision and Hearing Services Handbook
(posted May 29, 2020)

Notes:
Replaced incorrect procedure code 9902 in section 4.3.5.10, "Ophthalmoscopy and Extended Ophthalmoscopy," with correct procedure code 92202.

 

May 2020 Release Notes

Handbook

Related Articles and Notes

Section 1: Provider Enrollment and Responsibilities
(posted April 30, 2020)

Related Articles:
TMHP Approved Vendor for Credit Balance and Recovery
Information posted February 24, 2020

Notes:
Updated address locations to add accounting/mailing address.

Behavioral Health and Case Management Services Handbook
(posted April 30, 2020)

Related Articles:
Benefit Criteria to Change for Inpatient and Outpatient Mental Health Services for Texas Medicaid
Information posted April 17, 2020

Children’s Services Handbook: Medical services
(Sections 1-3 and 5-9)
(posted April 30, 2020)

Related Articles:
April 2020 Second Quarter NCCI Updates for Texas Medicaid
Information posted March 20, 2020

Notes:
Updated link in Section 7.5, “Assistance with Program,” to direct providers to the appropriate HHS THSteps web page for program information.

For clarify purposes, removed statement, “Stainless steel crowns and permanent allmetal cast crowns are not reimbursed on anterior permanent teeth (6-11, 22-27),” from section 4.2.15, “Restorative Services.”

Clinician-Administered Drugs (CAD) Handbook
(posted April 30, 2020)

Related Articles:
Tildrakizumab (Ilumya) to Become a Benefit of Texas Medicaid Effective May 1, 2019
Information posted August 7, 2019

Clinics and Other Outpatient Facility Services Handbook
(posted April 30, 2020)

Notes:
Corrected hyperlinks to direct providers to the appropriate CMS NCCI web page.

Removed hyperlink to NCCI policy manual in section 2.4.2.1, “National Correct Coding Initiative (NCCI and Medically Unlikely Edit (MUE) Guidelines.” Other sections throughout the provider manual do not include a hyperlink.

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook
(posted April 30, 2020)

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

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook
(posted April 30, 2020)

Related Articles:
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

Notes:
Updated link in Section 9.2.34.3, “Vaccine Adverse Event Reporting System (VAERS),” to direct providers to the appropriate web page for the Reportable Events Table.

Radiology and Laboratory Services Handbook
(posted April 30, 2020)

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

 

April 2020 Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 1: Provider Enrollment and Responsibilities
(posted March 31, 2020)

Related Articles:
Reminder: Provider Enrollment Revalidation Requirements
Information posted March 20, 2020

Notes:
Removed invalid Provider EVV Vendor Selection Form from section 1.13, “Forms.”

Volume 2: Behavioral Health and Case Management Services Handbook
(posted March 31, 2020)

Related Articles:
Reminder: Claims Filing for Opioid Treatment Providers
Information posted February 28, 2020

Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)
(posted March 31, 2020)

Notes:
Added procedure codes to the OEFV limitation statement in subsection 5.3.12.1, "Oral Evaluation and Fluoride Varnish (OEFV) in the Medical Home."

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook
(posted March 31, 2020)

Related Articles:
Definition Clarification for Back-up and Replacement Ventilators for Respiratory Equipment and Supplies
Information posted March 6, 2020

Therapeutic Continuous Glucose Monitors to Become a Benefit of Texas Medicaid April 1, 2020
Information posted March 6, 2020

Inpatient and Outpatient Hospital Services Handbook
(posted March 31, 2020)

Notes:
Removed procedure codes 55862, 55865, and 92974 for ASC and HASC facilities

Medicaid Managed Care Handbook
(posted March 31, 2020)

Notes:
Revised and reorganized language throughout handbook.

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook
(posted March 31, 2020)

Related Articles:
Benefit Changes for Gene Expression Profiling Procedure Code 81519 Effective March 1, 2020
Information posted January 10, 2020

Correction to ‘Allergy Testing Evaluation and Management Limitation Language Updated’
Information posted February 27, 2020

Radiology and Laboratory Services Handbook
(posted March 31, 2020)

Related Articles:
Limitation for Specimen Validity Testing Procedure Codes
Information posted February 14, 2020

Notes:
Revised language regarding waived tests and use of modifier QW for CLIA certificates.

 

March 2020 Release Notes

Handbook

Related Articles and Notes

Section 1: Provider Enrollment and Responsibilities
(posted February 28, 2020)

Related Articles:
Update to Automated Provider Licensure Information System
Information posted February 28, 2020

Notes:
Revised language regarding outpatient behavioral health services performed by licensed professionals.

Revised language and added subsection to clarify claims filing during enrollment.

Updated language to clarify Texas Health Steps-Medical alternate addresses require a separate application

Section 6: Claims Filing
(posted February 28, 2020)

Notes:
Added bullet to specify providers can continue to file claims when revalidating an existing enrollment.

Behavioral Health and Case Management Services Handbook
(posted February 28, 2020)

Related Articles:
Updated Benefit Information for MAT Services for Texas Medicaid March 1, 2020
Information posted February 7, 2020

Children’s Services Handbook: THStesps Dental Services (section 4), and Medical services (Sections 1-3 and 5-9)
(posted February 28, 2020)

Notes:
Added text to specify that FQHCs and RHCs are not required to be enrolled as THSteps providers in subsection 5.2.1, "THSteps Medical Provider Enrollment."

Updated parental accompaniment statement in section 4.2.25, "Orthodontic Services (THSteps)," for consistency with the legally approved parental accompaniment language.

Clinics and Other Outpatient Facility Services Handbook
(posted February 28, 2020)

Notes:
In section 4.3.1, "Claims Information," the last sentence in the first paragraph was rearranged to be listed as the first sentence at the beginning of the paragraph for clarity purposes.

Inpatient and Outpatient Hospital Services Handbook
(posted February 28, 2020)

Related Articles:
Update to Texas Medicaid Provider Procedures Manual, Inpatient and Outpatient Hospital Handbook
Information posted January 17, 2020

Notes:
Removed Stereotactic Radiosurgery section from the handbook.

Removed "refer to" in subsection 4.2.7, "Chemotherapy Administration."

Removed outdated statement referencing Milliman Care Guidelines from subsection 3.6.2, "Recommendations to Enhance Compliance with Texas Medicaid Fee-for-Service Hospital Claims Submission."

Added new subsection to specify outpatient observation services.

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook
(posted February 28, 2020)

Notes:
Removed the Chemotherapy section from the handbook.

Medical Transportation Program Handbook
(posted February 28, 2020)

Notes:
Removed lodging and meal provider sections.

Telecommunication Services Handbook
(posted February 28, 2020)

Related Articles:
Telehealth Services Will Become a Benefit for Early Childhood Intervention Providers Effective March 1, 2020
Information posted January 6, 2020

 

February 2020 Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 1: Provider Enrollment and Responsibilities
(posted January 31, 2020)

Notes:
Revised the language regarding enrollment effective dates in subsection 1.1.7, “Provider Enrollment Application Determination."

Behavioral Health and Case Management Services Handbook
(posted January 31, 2020)

Notes:
Added language regarding prior authorization submission to subsection 9.9.4, "Prior Authorization for Residential Treatment Services."

Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) and THSteps Dental services (Section 4)
(posted January 31, 2020)

Related Publications:
2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17
Information posted December 31, 2019

2020 HCPCS Updates for Texas Medicaid SHARS Program – Counseling and Psychological Services
Information posted January 23, 2020

Clinics and Other Outpatient Facility Services Handbook
(posted January 31, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17
Information posted December 31, 2019

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook
(posted January 31, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17
Information posted December 31, 2019

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook
(posted January 31, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17
Information posted December 31, 2019

Diagnostic Doppler Sonography Benefits to Change for Texas Medicaid February 1, 2020
Information posted December 13, 2019

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

Allergy Testing Evaluation and Management Limitation Language Updated
Information posted December 13, 2019

Radiology and Laboratory Services Handbook
(posted January 31, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17
Information posted December 31, 2019

Limitation Update for Urinalysis and Chemistry Procedure Code 84583 Effective February 1, 2020
Information posted December 13, 2019

Telecommunication Services Handbook
(posted January 31, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17
Information posted December 31, 2019

Vision and Hearing Services Handbook
(posted January 31, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17
Information posted December 31, 2019

Women’s Health Services Handbook
(posted January 31, 2020)

2020 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 17
Information posted December 31, 2019

   

January 2020 Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 1: Provider Enrollment and Responsibilities
(posted December 31, 2020)

Notes:
Updated links in subsections 1.1.9.9, "Franchise Tax Account Status Page," and 1.3.1, "Excluded Entities And Providers."

Volume 1: Section 5: Fee-for-Service Prior Authorizations
(posted December 31, 2020)

Notes:
Added language regarding a Change of Provider letter in section 5.9, "Closing a Prior Authorization."

Volume 1: Section 6: Claims Filing
(posted December 31, 2020)

Notes:
Updated Claims Filing Deadline calendars in subsections 6.1.4 and 6.1.6.

Vision and Hearing Services Handbook
(posted December 31, 2020)

Related Articles:
Benefit Changes for Vision Services Non-Surgical Procedure Code 92242 Effective January 1, 2020
Information posted December 20, 2019