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Vestibular Evoked Myogenic Potentials (VEMP) Claims Reprocessing

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The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue with claims submitted for dates of service from June 1, 2022, through October 25, 2022, with diagnosis code R111 and procedure codes 92517, 92518, and 92519 for Children with Special Health Care Needs (CSHCN) Services Program clients. These claims might have been processed with diagnosis code R111 in error. Diagnosis code R111 is invalid.

Diagnosis codes R1110 and R1111 are appropriate and should be used when submitting claims with procedure codes 92517, 92518, and 92519.

Affected claims submitted for dates of service from June 1, 2022, through October 25, 2022, may be reprocessed. When the claims are reprocessed, providers may receive additional payment, which will be reflected on Remittance and Status (R&S) Reports.

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