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Updated Taxonomy Codes Effective for Some Medicaid and CSHCN Services Program Providers on October 1, 2021

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective October 1, 2021, a new taxonomy code will be added for physicians providing epilepsy services for Texas Medicaid and the Children with Special Health Care Needs Services Program. Additionally, the taxonomy crosswalk has been updated to allow Home Health services providers to utilize additional taxonomy codes for related services. 

Providers can log into the Provider Information Management System (PIMS) to make updates to their taxonomy code.

New Taxonomy Code

The following new taxonomy code will be added and will apply for allopathic & osteopathic physicians; psychiatry & neurology:

Provider Type Taxonomy Code
Home Health 2084E0001X (Epilepsy is a subspecialty of neurology focused on the diagnosis and treatment of patients with epilepsy, including new-onset, medically refractory epilepsy, psychogenic nonepileptic seizures, and epilepsy in special populations [the elderly, women, patients with co-morbidities]. Epilepsy is a multidisciplinary field that provides comprehensive care of the patient.)

Taxonomy Modifications

The following Taxonomy Codes were updated to apply to home health services providers:

Provider Type Taxonomy Code
Home Health 3747P1801X (An individual who aids with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards.)
Home Health 225XP0019X (Occupational therapists are experts at helping people lead as independent a life as possible. Occupational therapists bring an understanding of the physical and psychological implications of illness and injury and their effects on peoples' ability to perform the tasks of daily living. Occupational therapists provide interventions that can aide a person in completing ADL and IADL tasks, such as dressing, bathing, preparing meals, and driving. They also may fabricate custom orthotics to improve function, evaluate the environment for safety hazards and recommend adaptations to remove those hazards, help a person compensate for cognitive changes, and build a persons’ physical endurance and strength. Occupational therapists' knowledge of adapting tasks and modifying the environment to compensate for functional limitations is used to increase the involvement of clients and to promote safety and success.)
Home Health Agencies 251X00000X (A provider of service/function that assists participating individuals to make informed decisions about what will work best for them is consistent with their needs and reflects their individual circumstances. Serving as the agent of the individual, the service is available to assist in identifying immediate and long-term needs, developing options to meet those needs and accessing identified supports and services and may include assistance with recruiting, screening, hiring, and training in-home support providers. A family or person-centered planning approach is used. Supports Brokerage offers practical skills training to enable families and individuals to remain independent. Examples of skills training include providing information on recruiting and hiring personal care workers, managing personal care workers and providing information on effective communication and problem solving. The service/function provides sufficient information to assure that individuals understand the responsibilities involved with self-direction and assist in the development of an effective back-up and emergency plan. Plans may elect to fulfill the requirement of this service/function using a self-directed case manager or creating a distinct service. The Supports Brokerage documents the need for assistive services, planning for and documenting the use of excess funds and locating and maintaining services.)

Providers may refer to the X12 website for complete descriptions of the taxonomy codes.

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