CSHCN Policy Updates
The following CSHCN policy changes have been made to support the second quarter 2007 HCPCS updates.
CSHCN Home Health Respiratory Equipment and Supplies
The following procedure codes are benefits of the CSHCN Services Program with the following limitations:
|
Procedure Code |
Limitation |
|
J-K0553 |
1 every 3 months |
|
J-K0554 |
2 per month |
|
J-K0555 |
2 per month |
CSHCN Reconstructive Cosmetic Procedures
Procedure codes 2/8-S2066 and 2/8-S2067 are benefits of the CSHCN Services Program if they are submitted with diagnosis code 1740, 1741, 1742, 1743, 1744, 1745, 1746, 1748, 1749, 1750, 1759, 19881, 2330, or V103. Procedure codes 2/8-S2066 and 2/8-S2067 are considered for reimbursement to physicians in the inpatient and outpatient hospital settings.
CSHCN Outpatient Speech Language Pathology Services
Procedure code 1-S9152 is a benefit of the CSHCN Services Program and may be considered for reimbursement of a reevaluation once every calendar month. Providers must not use procedure code 1-92506 with the U4 modifier to submit claims for a reevaluation.
Procedure code 1-S9152 may be submitted by the following providers in the office, home, inpatient and outpatient hospital, and other settings:
|
Setting |
Providers |
|
Office |
Physicians and speech and hearing clinics |
|
Home |
Home health agencies |
|
Outpatient hospital |
Physicians, hospitals, and rehabilitation centers |
|
Other |
Physicians, speech and hearing clinics, home health agencies, hospitals and rehabilitation centers |
Second Quarter 2007 HCPCS Additions
The following is a list of new procedure codes that do not replace existing codes. All procedure codes that require a rate hearing are indicated with an asterisk in the Allowable column.
|
Procedure Code |
Allowable |
|
1-C1716 |
NC |
|
1-C1717 |
NC |
|
1-C1719 |
NC |
|
1-C2616 |
NC |
|
1-C2634 |
NC |
|
1-C2635 |
NC |
|
1-C2636 |
NC |
|
1-C2637 |
NC |
|
1-C2638 |
NC |
|
1-C2639 |
NC |
|
1-C2640 |
NC |
|
1-C2641 |
NC |
|
1-C2642 |
NC |
|
1-C2643 |
NC |
|
1-C2698 |
NC |
|
1-C2699 |
NC |
|
1-C9728 |
NC |
|
J-K0553 |
* |
|
J-K0554 |
* |
|
J-K0555 |
* |
|
1-Q4087 |
NC |
|
1-Q4088 |
NC |
|
1-Q4090 |
NC |
|
1-Q4091 |
NC |
|
1-Q4092 |
NC |
|
1-Q4093 |
NC |
|
1-Q4094 |
NC |
|
1-Q4095 |
* |
|
2/8-S2066 |
* |
|
2/8-S2067 |
* |
|
(*) Reimbursement pending rate hearing. (NC) Not covered |
Reminder: Services that are provided before rates have been adopted through the rate hearing process will be denied as part of another service until the applicable reimbursement rate has been adopted. The client cannot be billed for these services. TMHP will reprocess claims after the applicable reimbursement rates have been adopted. Providers should submit claims for the procedure codes as the services are performed so that all filing deadlines are met. Providers are responsible for meeting all filing deadlines and for appealing any claims that are denied between July 1, 2007, and the date on which the reimbursement rate is implemented.
For more information, call the TMHP-CSHCN Contact Center at 1-800-568-2413.