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2024 TMPPM Release Notes

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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 2023, see the 2023 Release Notes

April 2024 TMPPM Release Notes
HandbookRelated Articles and Notes
Volume 1: Section 5: Fee-for-Service Prior Authorizations

New Radiology Prior Authorization Form Now Available

Information posted April 12, 2024

Children’s Services Handbook: Medical services (Sections 1–2 and 4–8)Added symbol and text for QW modifier requirement to procedure code 85018 in the table of section 4.3.12.6, “Laboratory Test.”
Clinics and Other Outpatient Facility Services Handbook

Maintenance Dialysis Benefits for Texas Medicaid Changed on March 1, 2024

Information posted March 11, 2024

Healthy Texas Women (HTW) Program Handbook

QW Modifier Requirement and Claims Reprocessing for Some CLIA Procedure Codes

Information posted March 22, 2024

Inpatient and Outpatient Hospital Services Handbook

New Radiology Prior Authorization Form Now Available

Information posted March 31, 2024

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Prior Authorization Criteria for Sacroiliac Joint Fusion Effective January 1, 2024

Information posted February 15, 2024

Outpatient Drug Services Handbook

Moved sections 6.5, “Afamelanoride Implant (Scenesse),” and 6.6, “Ajovy (Fremanezumab-vfrm),” up above section 6.4, “Alzheimer's Disease (AD),” to be listed in alphabetical order.

Moved section 6.111, “Talquetamab-tgvs (Talvey),” to be placed in alphabetical order after section “Tagraxofusp-erzs (Elzonris).”

Updated Prior Authorization Criteria for Delandistrogene Moxeparvovec-rokl (Elevidys) Effective April 1, 2024

Information posted March 22, 2024

Radiology and Laboratory Services Handbook

QW Modifier Requirement and Claims Reprocessing for Some CLIA Procedure Codes

Information posted March 22, 2024

New Radiology Prior Authorization Form Now Available

Information posted April 12, 2024

 

March 2024 TMPPM Release Notes
HandbookRelated Articles and Notes
Volume 1: Section 1: Provider Enrollment and ResponsibilitiesAdded provider types to Medicare-waiver eligible list in section 1.1.9.10.
Volume 1: Section 2: Texas Medicaid Fee-for-Service ReimbursementAdded LMFTs and LPCs to section 2.7.5.1.
Volume 1: Section 6: Claims Filing

Updated holiday calendar to include Emancipation Day.

Removed language from header row in POS coding table.

New National POS 27 and Update to Local POS 2 for Texas Medicaid and CSHCN Claim Systems

Information posted February 9, 2024

Behavioral Health and Case Management Services Handbook

Changed footer in table to say "primary codes". Updated the note in Table B from "Psychotherapy add-on code must be billed with an E/M code" to "Psychotherapy add-on code must be billed with the appropriate primary code".

Updated language for LMFT and LPC provider types in sections 4.1.5 and 4.1.6.

Added plus signs and footer to table; removed note indicating asterisks.

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Updates to Diabetic Equipment and Supplies Benefit Information Effective March 1, 2024

Information posted January 12, 2024

Healthy Texas Women (HTW) Program Handbook

Healthy Texas Women Program Benefit Updates Effective March 1, 2024

Information posted February 2, 2024

Medical and Nursing Specialists, Physicians, and Physician Assistants HandbookRemoved relationship statement "Procedure code 33947 is denied as part of procedure code 33949 if submitted with the same date of service," in section 9.2.29, "Extracorporeal Membrane Oxygenation (ECMO)."
Vision and Hearing Services Handbook

Update to the TMPPM Vision and Hearing Services Handbook Effective March 1, 2024

Information posted February 23, 2024

 

February 2024 TMPPM Release Notes
HandbookRelated Articles and Notes
Behavioral Health and Case Management Services Handbook

TMPPM Update for Attestation Form for Collaborative Care Model to Be Submitted in PEMS Effective February 1, 2024

Information posted December 22, 2023

2024 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 29, 2023

Children’s Services Handbook: Appendix B: Immunizations

2024 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 29, 2023

Reimbursement Rate Updates for RSV Vaccine Procedure Code 90678 Effective October 1, 2023, for Texas Health Steps

Information posted December 21, 2023

RSV Monoclonal Antibody Nirsevimab Is a Benefit of Texas Medicaid

Information posted January 11, 2024

Children’s Services Handbook: Appendix F: THSteps Quick Reference Guide

RSV Vaccine Procedure Code 90678 is Now a Benefit for Pregnant Individuals Effective October 1, 2023

Information posted December 7, 2023

2024 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 29, 2023

Children’s Services Handbook: Medical services (Sections 1-2 and 4-8)

RSV Monoclonal Antibody Nirsevimab Is a Benefit of Texas Medicaid

Information posted January 11, 2024

Reimbursement Rate Updates for RSV Vaccine Procedure Code 90678 Effective October 1, 2023, for Texas Health Steps

Information posted December 21, 2023

2024 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 29, 2023

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Prior Authorization Language to Change for Continuous Glucose Monitoring Procedure Codes 95250 and 95251 Effective February 1, 2024

Information posted December 15, 2023

Changed language in section 2.2.12.7.1 to update "health-care provider" to "treating practitioner.”

Updated Prior Authorization Criteria for Diabetic Equipment and Supplies Effective February 1, 2024

Information posted December 18, 2023

Healthy Texas Women (HTW) Program Handbook

Removed E/M from note in section 2.3.11.1.

2024 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 29, 2023

Replaced broken LARC hyperlink with new one.

Inpatient and Outpatient Hospital Services HandbookUpdated broken CLIA hyperlink with correct link.
Medicaid Managed Care HandbookUpdated broken URL in for VPD eligibility to new URL.
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

2024 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 29, 2023

TMPPM Update for Attestation Form for Collaborative Care Model to Be Submitted in PEMS Effective February 1, 2024

Information posted December 22, 2023

RSV Vaccine Procedure Code 90678 is Now a Benefit for Pregnant Individuals Effective October 1, 2023

Information posted December 7, 2023

RSV Monoclonal Antibody Nirsevimab Is a Benefit of Texas Medicaid

Information posted January 11, 2024

Prior Authorization Language to Change for Continuous Glucose Monitoring Procedure Codes 95250 and 95251 Effective February 1, 2024

Information posted December 15, 2023

Outpatient Drug Services Handbook

Prior Authorization Criteria for Nadofaragene Firadenovec-vncg (Adstiladrin) Effective February 1, 2024

Information posted January 19, 2024

Prior Authorization Criteria for Beremagene Geperpavec-svdt (Vyjuvek) Effective February 1, 2024

Information posted January 12, 2024

Prior Authorization Criteria for Valoctocogene Roxaparvovec-rvox (Roctavian) Effective February 1, 2024

Information posted January 19, 2024

2024 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 29, 2023

Update to TMPPM Outpatient Drug Services Handbook Effective February 1, 2024

Information posted January 22, 2024

Prior Authorization Criteria for Enzyme Replacement Therapy Procedure Codes J0217 and J2508 Effective February 1, 2024

Information posted January 12, 2024

Prior Authorization Criteria for Delandistrogene Moxeparvovec-rokl (Elevidys) Effective February 1, 2024

Information posted January 5, 2024

Radiology and Laboratory Services Handbook

2024 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 29, 2023

Telecommunication Services HandbookIn section 3.7.1, Prior Authorization of Telemonitoring Services, added statement that procedure code 99091 does not require prior authorization, and also added documentation statement related to prior authorization denials. In section 4.1.1, Telemonitoring Services, added reimbursement statement for procedure code S9110 when submitting a claim for a subsequent set up and installation of telemonitoring equipment.
Vision and Hearing Services Handbook

2024 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 29, 2023

 

January 2024 TMPPM Release Notes
HandbookRelated Articles and Notes
Volume 1: Section 1: Provider Enrollment and ResponsibilitiesChanged language in section 1.3 to clarify PE disenrollment process.
Volume 1: Section 6: Claims Filing

Updated the 2023 claims filing holiday and deadline information for 2024.

Updated language in section 6.4.2.4 to reflect updated PE process.

Children’s Services Handbook: THSteps Dental services (Section 3)Updated statement within section 3.1, "Enrollment," to reflect the appropriate request to be utilized through Provider Enrollment and Management System (PEMS). Removed statements that are no longer valid for the current enrollment process.
Clinics and Other Outpatient Facility Services HandbookRevised statements within section 8.1, "Enrollment," to align with the current enrollment process and indicate the appropriate source that the National Provider identier is issued from as National Plan and Provider Enumeration System (NPPES).
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Updated statement within section 6.1, "Provider Enrollment," to reflect the appropriate request to be utilized through Provider Enrollment and Management System (PEMS).

New Procedure Codes for Diaphragm-Pacing Neuromuscular Stimulation Effective January 1, 2024

Information posted December 15, 2023

Updated statement within section 5.1.1, "Geneticists," to reflect the appropriate assignee of the National Provider Identifier as National Plan and Provider Enumeration System (NPPES).

Updated statement within section 3.1, "Provider Enrollment," to reflect the appropriate request to be utilized through Provider Enrollment and Management System (PEMS).

Outpatient Drug Services Handbook

Prior Authorization Criteria for Procedure Code J0490 Now Available In Lupus Treatment Agents Section of TMPPM Outpatient Drug Services Handbook

Information posted November 27, 2023