Medicaid Policy Updates

The following Texas Medicaid Program policy changes have been made to support the Second Quarter 2007 HCPCS updates.

Home Health Respiratory Equipment and Supplies

The following procedure codes are benefits of the Texas Medicaid Program with the following limitations:

Mastectomy and Breast Reconstruction

Procedure codes 2/8-S2066 and 2/8-S2067 are benefits of the Texas Medicaid 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.

Speech Language Pathology Services and Speech Therapy

Procedure code 1-S9152 is a benefit of the Texas Medicaid Program and may be submitted for reimbursement of a reevaluation once every 30 days. Providers must not use procedure code 1-92506 with the U4 modifier to submit claims for a reevaluation.

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.

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 Contact Center at 1-800-925-9126.