Effective for dates of service on or after July 1, 2007, procedure code 1-S9152 is a benefit of the Texas Medicaid Program and the Children with Special Health Care Needs (CSHCN) Services Program and may be submitted for reimbursement of a reevaluation once per calendar month. Advanced practice nurses (APNs) (including nurse practitioners, clinical nurse specialists, and physician assistants), physicians, Comprehensive Care Program (CCP) providers, home health agencies, hospitals, and rehabilitation centers must submit procedure code 1-92506 for the initial evaluation and procedure code 1-S9152 for a reevaluation. Effective for dates of service on or after July 1, 2007, the providers listed above must not use procedure code 1-92506 with modifier U4 to submit claims for a reevaluation.

Effective for dates of service on or after September 1, 2007, the reimbursement rate for procedure code 1-S9152 was increased from $119.61 to $210.00.

Note: School Health and Related Services (SHARS) providers must submit procedure code 1-92506 with modifier GN or U9 for speech language pathology (SLP) and audiology evaluations. Procedure code 1-S9152 is not a benefit for SHARS providers.

For additional information about SLP services, Texas Medicaid Program providers can refer to the 2008 Texas Medicaid Provider Procedures Manual, Section 36.4.46, “Speech-Language Therapy,” on page 36-130; Section 43.4.4.3, “Benefits and Limitations,” on page 43-43; and Section 43.4.16.3, “Benefits and Limitations,” on page 43-91. CSHCN Services Program providers can refer to the 2008 CSHCN Services Program Provider Manual, Section 29.2, “Reimbursement,” on page 29-2.

For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413.