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SHARS Benefits for Texas Medicaid Will Change on October 1, 2025

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Effective for dates of service on or after October 1, 2025, School Health and Related Services (SHARS) benefits will change for Texas Medicaid.

Overview of Benefit Changes

Changes to this medical benefit include the following:

  • Revised provider requirements for personal care services (PCS)
  • Updated benefit information for audiology services

Revised PCS Provider Requirements

PCS must only be provided by an individual employed by or contracted with the local education agency (LEA). The individual must:

  • Meet the requirements of 42 CFR § 440.167.
  • Demonstrate the understanding and competence necessary to perform the eligible PCS tasks required by a student’s individualized education program (IEP), including written documentation procedures.

The LEA may use one of the following methods to determine that the individual is qualified to perform PCS in the two competence areas:

  • Review of the individual’s education, related certification, or related training
  • Evaluation from one or more qualified employees of the LEA verifying competence, who may additionally consider work experience, evaluations from other qualified employees of the LEA, and on-site demonstration

For the purposes of verifying PCS provider qualifications, a qualified employee of the LEA is defined as any of the following:

  • An individual with current special education teacher certification under 19 Texas Administrative Code (TAC) §233.8 whose work responsibilities include working with PCS providers
  • An individual whose primary work responsibilities include supervising, training, and confirming the qualifications of PCS providers
  • A licensed health care practitioner eligible to provide reimbursable services under a SHARS benefit other than PCS

LEAs must document the PCS provider's ability to perform general assistance with ADLs and IADLs for students enrolled in special education. The LEA must keep a statement that:

  • Is signed and dated by a qualified employee of the LEA.
  • Verifies that the individual can perform PCS tasks under the direction of a qualified employee of the LEA, in accordance with the required PCS competence areas.
  • Is stored in a centralized location.

The LEA may provide training if the individual lacks understanding and competence in an area of PCS.

Audiology Services

Audiology services must be provided by a professional who holds a valid state license as an audiologist.

An audiology assistant or intern in audiology, who is licensed by the state, may provide services within the guidelines of state licensure when the assistant or intern is acting under the supervision of a qualified audiologist.

Functional listening evaluations are not a benefit.

Procedure Code Updates

The following procedure code and modifier combinations will no longer be a benefit for SHARS audiology services:

  • Procedure code 92507 with modifier U1 or U9
  • Procedure code 92508 with modifier U1 for U9

The following procedure code and modifier combinations will become a benefit for SHARS audiology services:

Procedure CodeIndividual or GroupProviderStudent PopulationUnit of Service
92552 with modifier TMIndividualLicensed audiologistIEPUntimed
92552 with modifier U4IndividualLicensed audiologist504Untimed
92555 with modifier TMIndividualLicensed audiologistIEPUntimed
92555 with modifier U4IndividualLicensed audiologist504Untimed
92567 with modifier TMIndividualLicensed audiologistIEPUntimed
92567 with modifier U4IndividualLicensed audiologist504Untimed
92568 with modifier TMIndividualLicensed audiologistIEPUntimed
92568 with modifier U4IndividualLicensed audiologist504Untimed
92582 with modifier TMIndividualLicensed audiologistIEPUntimed
92582 with modifier U4IndividualLicensed audiologist504Untimed
92630 with modifier TMIndividualLicensed audiologistIEPUntimed
92630 with modifier U4IndividualLicensed audiologist504Untimed
92633 with modifier TMIndividualLicensed audiologistIEPUntimed
92633 with modifier U4IndividualLicensed audiologist504Untimed

Tympanometry (procedure code 92567) and acoustic reflex testing (procedure code 92568) will each be limited to one per day, any provider.

The use of procedure codes 92552, 92555, 92567, 92568, and 92582 implies that testing is performed in both ears. Audiologists must use modifier 52, reduced services, if a test is applied to one ear instead of both.

Auditory rehabilitative treatment (procedure codes 92630 and 92633) will be limited to one per day, any provider. Session notes for therapy services (procedure codes 92630 and 92633) will be required.

Audiometry

Audiometry is the testing of a person’s ability to hear various sound frequencies and is performed with the use of calibrated electronic equipment. The results of the audiometry test may be recorded on a grid or graph called an audiogram. Audiometry is used to identify and diagnose hearing loss.

Pure tone audiometry procedure code 92552 will be limited to one per day, any provider. If procedure codes 92552 and 92553 are billed for the same date of service, same provider, and same student, procedure code 92553 will be reimbursed and procedure code 92552 will be denied.

Speech audiometry threshold procedure code 92555 will be limited to one per day, any provider. If procedure codes 92555 and 92556 are billed for the same date of service, same provider, and same student, procedure code 92556 will be reimbursed and procedure code 92555 will be denied.

If procedure code 92552 or 92555 is billed for the same date of service, same provider, and same student as procedure code 92557, procedure code 92557 will be reimbursed and procedure codes 92552 and 92555 will be denied.

Conditioning play audiometry (procedure code 92582) will be limited to one per day, any provider.

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