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Wound Care Management Services Procedure Code Changes for Q4159 and Q4145 Effective March 1, 2023

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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.

Effective for dates of service on or after March 1, 2023, wound care management services procedure code Q4159 will become a benefit of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Also effective for dates of service on or after March 1, 2023, wound care management services procedure code Q4145 will no longer be a benefit of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Reimbursement

The following provider types and place of service may be reimbursed for clients of all ages for procedure code Q4159:

Medicaid

Provider Type

Place of Service

County Indigent, Physicians, Clinic/Group Practice, Dentist and Dentistry Group, Podiatrist and Podiatrist Group

Office

CSHCN Services Program

Provider Type

Place of Service

Physicians, Clinic/Group Practice, Dentist and Dentistry Group, Podiatrist and Podiatrist Group

Office

Note: Separate reimbursement for the approved skin substitute product (Q4159) and the associated procedure codes (15271–15278) are payable when wound care services are provided in an office setting on the same day.

A maximum of 10 skin substitute applications can be performed in a 12-week period per rolling year.

If more than 10 skin substitute applications are requested, approval will be considered on a case-by-case basis. These requests will be reviewed by the medical director and documentation of medical necessity will be required.

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