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Update to the Durable Medical Equipment and Supplies Handbook

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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.

On November 1, 2021, TMHP will update the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment and Supplies Handbook, subsection 2.2.18.1, “Enteral Nutritional Products, Feeding Pumps, and Feeding Supplies,” to clarify coverage for procedure code B9998.

Procedure code B9998 may be reimbursed as needed without a modifier or with modifiers U1-U5 and limitations. In addition, a backpack or carrying case for a portable enteral nutrition infusion pump may be a benefit of Home Health Services when medically necessary and prior authorized, using procedure code B9998.

For more information, call the TMHP Contact Center at 800-925-9126.