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Important Reminder: Use Latest ICD-10 Codes for Compliant Claims and Applications

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Providers must use the most current and accurate International Classification of Diseases (ICD) codes for diagnoses and procedures when submitting claims or applications for the Children with Special Health Care Needs (CSHCN) Services Program.

Submitting outdated or incorrect codes on the Physician/Dentist Assessment Form (PAF) can lead to:

  • Delays in processing a patient’s application.
  • Denial of a patient’s application, even if they have an approved diagnosis, which could result in the requested services not being authorized or reimbursed.
  • Financial burdens for both providers and patients.

Important: Providers should consult the Centers for Medicare & Medicaid Services ICD web page to ensure they are using the latest ICD-10 codes.

CSHCN Services Program eligibility criteria, requirements, and PAF can be found on the CSHCN Services Program web page.

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