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Clarification of Wheeled Mobility System Benefit Information in the TMPPM

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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.

On May 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update language in the Texas Medicaid Provider Procedures Manual (TMPPM), Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook to clarify information about modifications, adjustments, and repairs to a wheeled mobility system.

All modifications, adjustments, and repairs to a wheeled mobility system that occur within the first six months after delivery are considered part of the purchase price. An exception is the push-rim activated power assist wheelchair (PAPAW) system, which may be considered for prior authorization with a new seating assessment form within the first six months after fitting and delivery.

Rental of a wheeled mobility system during the time of repair should be offered at the time of equipment pickup if appropriate.

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