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TMPPM Update Clarification Language for Quantity Limitations for Diaper Wipes

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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, precertification, 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 January 1, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, Section 2.2.15.3 “Diaper Wipes,” and Section 2.2.15.9 “Incontinence Procedure Codes with Limitations,” to clarify quantity limitation language for diaper wipes.

Section 2.2.15.3 Diaper Wipes

The following are the revised and updated statements:

For clients who are 4 years of age or older and are receiving diapers/briefs/pull-ons, up to 2 boxes of diaper wipes per month do not require prior authorization. Additional quantities may be considered with documentation of medical necessity and prior authorization.

  • For clients who are 4 years through 20 years of age, additional quantities are considered through the Texas Health Steps Comprehensive Care Program (CCP).
  • For clients who are 21 years of age or older, additional quantities are considered through the Texas Medicaid Home Health-Durable Medical Equipment (DME) Exceptional Circumstances process.

Section 2.2.15.9 Incontinence Procedure Codes with Limitations

The following are the revised and updated statements:

Any service or combination of services requires prior authorization if the maximum limitation is exceeded.

Requests for prior authorization of diaper wipes that exceed more than 2 boxes per month will be considered through Texas Health Steps-CCP for clients who are 4 years through 20 years of age and through the Texas Medicaid Home Health-Durable Medical Equipment (DME) Exceptional Circumstances process for clients who are 21 years of age or older.

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