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Update on Case Management for CPW Policy Changes and COVID-19 Flexibilities

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This article has been updated. To view the updated information, see “Correction to ‘Update on Case Management for CPW Policy Changes and COVID-19 Flexibilities.’”

This article has been updated. To view the updated information, see “Multiple COVID-19 Flexibilities for Services Ending.”

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

The Texas Health and Human Services Commission (HHSC) is updating the direction and providing clarification related to COVID-19 flexibilities for Case Management for Children and Pregnant Women (CPW) services and guidance on National Correct Coding Initiative (NCCI) practices for CPW claims.

Effective September 1, 2022, CPW comprehensive visits and follow-up visits completed through the use of synchronous audiovisual technology are benefits of Texas Medicaid.

Providers can refer to the Behavioral Health and Case Management Services Handbook and the Telecommunication Services Handbook in the Texas Medicaid Provider Procedures Manual and the article “Changes to Case Management for Children and Pregnant Women, Including Teleservices, Effective September 1, 2022” published on on July 18, 2022, for additional details.

The COVID-19 flexibilities for CPW services outlined below will remain in place until HHSC provides further direction. Please note that the flexibilities have been updated to align with NCCI practices.

  • CPW services, including comprehensive visits, may be completed by telephone (audio-only telecommunications).
  • When submitting a new prior authorization (CM-01) for a comprehensive visit to be completed using telephone (audio-only telecommunications), include “telephone comprehensive visit will be completed due to COVID-19” within the psychosocial section of the prior authorization request form.
  • Modifier 93 must be included on the claim form when the comprehensive visit or follow-up visit is completed using telephone (audio-only) telecommunications.

Procedure Codes and Modifiers


Submitted Procedure Code

Modifier 1

Modifier 2

Modifier 3

Comprehensive visit (in-person or synchronous audiovisual)





Follow-up visit (in-person or synchronous audiovisual)




For CPW services delivered through an MCO, providers must refer to the MCO for information about benefits, limitations, prior authorization, reimbursement, and specific claim processing procedures.

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