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2022 CSHCN Release Notes

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The following tables show the section and handbooks that were changed in the CSHCN Services Program Provider Manual. The changes are listed in reverse chronological order (newest first).

To see the changes made in 2021, see the 2021 Release Notes.

December 2022 CSHCN Provider Manual Release Notes

Chapter

Related Articles and Notes

No updates for December 2022.

November 2022 CSHCN Provider Manual Release Notes

Chapter

Related Articles and Notes

Appendix A: Acronyms

Removed TPI from acronym list.

Chapter 11: Blood Pressure Monitoring and Devices

2022 ICD-10 Special Bulletin

Chapter 14: Dental

Added prior authorization requirement statement, limitation statement, and documentation of medical necessity statement to procedure code D0367 in the table of subsection 14.2.3.5, "Radiographs or Diagnostic Imaging.”

Added limitation statements to the table of subsection 14.2.6.9, "Adjunctive General Services" for procedure codes D9420 and D9612. Changed "same provider" to "any provider" in the statement, "If more than two nonintravenous (IV) conscious sedation services are required by the same provider in a 12 month period, prior authorization is required.” Added medical necessity statement to subsection 14.2.7.1, “Dental Hospital Calls" for procedure code D9420.

Chapter 25: Laboratory Services

2022 ICD-10 Special Bulletin

Third Quarter 2022 HCPCS Updates for the CSHCN Services Program

Information posted September 30, 2022

Chapter 29: Outpatient Behavioral Health

2022 ICD-10 Special Bulletin

Chapter 31: Physician

2022 ICD-10 Special Bulletin

Third Quarter 2022 HCPCS Updates for the CSHCN Services Program

Information posted September 30, 2022

October 2022 CSHCN Provider Manual Release Notes

Chapter

Related Articles and Notes

Chapter 17: Durable Medical Equipment (DME)

Added authorization and replacement language to section 17.3.

Removed 1- from phone numbers.

Chapter 31: Physician

Restrictions to Be Updated for Some Injection Procedure Codes

Information posted September 30, 2022

September 2022 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

Updated Instructions and Resubmission Guidelines for UB-04 CMS 1450 Paper Claims

Information posted July 1, 2022

Chapter 9: Ambulance

CSHCN Emergency Triage, Treat, and Transport (ET3) Benefits for Ambulance Services Effective September 1, 2022

Information posted August 22, 2022

August 2022 CSHCN Release Notes

Chapter

Related Articles and Notes

Introduction

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

Chapter 1: TMHP and HHSC Contact Information

Changed PO box address from 149347 to 149030 in sections 1.1.2 and 1.3.1.

Chapter 2: Provider Enrollment and Responsibilities

Changed PO box address from 149347 to 149030 in section 2.2.

Chapter 3: Client Benefits and Eligibility

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

Changed PO box address from 149347 to 149030 in sections 3.2.8 and 3.3.2.

Chapter 4: Prior Authorizations and Authorizations

Changed PO box address from 149347 to 149030 in sections 4.5.3 and 4.5.4.

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

Changed PO box address from 149347 to 149030 in section 5.1.9.

Chapter 6: Remittance and Status (R&S) Reports

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

Chapter 7: Appeals and Administrative Review

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

Changed PO box address from 149347 to 149030 in sections 7.2.1, 7.2.2, 7.3.5, 7.3.6, and 7.4.

Chapter 8: Advanced Practice Registered Nurse (APRN [NP/CNS])

Reminder: TMHP Provider Enrollment and Management System (PEMS)

Information posted June 1, 2022

Chapter 14: Dental

Reminder: TMHP Provider Enrollment and Management System (PEMS)

Information posted June 1, 2022

Update to CSHCN Services Program Provider Manual for Dental Procedure Codes D0470 and D8670

Information posted June 17, 2022

Chapter 16: Diagnostic Radiology Services

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

Chapter 20: Hearing Services

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

Chapter 21: Home Health Services

Added limitation statement "Therapy evaluations or re-evaluations are limited to four per 180 days, any provider," to section 21.3.4, "Occupational Therapy (OT), Physical Therapy (PT), and Speech-Language Pathology (SLP) Services."

Chapter 24: Hospital

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

Chapter 25: Laboratory Services

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

Chapter 27: Neurostimulators and Neuromuscular Stimulators

Reminder: TMHP Provider Enrollment and Management System (PEMS)

Information posted June 1, 2022

Chapter 31: Physician

Second Quarter 2022 HCPCS Updates for the CSHCN Services Program

Information posted June 22, 2022

Chapter 38: Telecommunication Services

Reminder: TMHP Provider Enrollment and Management System (PEMS)

Information posted June 1, 2022

Chapter 40: Vision Services

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

Chapter 41: TMHP Electronic Data Interchange (EDI)

Update to "Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021"

Information posted September 1, 2021

July 2022 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 18: Expendable Medical Supplies

Updated limitation for 9-A4326 and 9-A4349 and added a new note to the footer table in section 18.2.1.

Chapter 24: Hospital

CSHCN Provider Manual Update for Emergency Inpatient Hospital Admissions

Information posted June 17, 2022

June 2022 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 7: Appeals and Administrative Review

Changed TPR to TPL in section 7.3.1.2.

Chapter 14: Dental

Benefit Criteria for Evoked Response Tests and Neuromuscular Procedures to Be Added Effective June 1, 2022

Information posted May 17, 2022

Update to TMPPM and CSHCN Services Program Provider Manual for Dental Procedure Codes D9910 and D9951

Information posted April 15, 2022

Removed the reimbursement limitation statement for procedure code D4341, and revised the limitation statement in the table of section 14.2.6.6, "Periodontics."

Chapter 21: Home Health Services

Updated CSHCN Prior Authorization Request for Medical Nutritional Products Form and Instructions Effective November 1, 2021

Information posted October 22, 2021

Chapter 31: Physician

Benefit Criteria for Evoked Response Tests and Neuromuscular Procedures to Be Added Effective June 1, 2022

Information posted May 17, 2022

May 2022 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 2: Provider Enrollment and Responsibilities

Reminder: TMHP Provider Enrollment and Management System (PEMS)

Information posted March 1, 2022

Beginning April 7, 2022, Occupational Therapist Providers Can Enroll as Groups and Performing Providers Within a Group

Information posted April 1, 2022

Changed TAC 38.6 to 351.6 in section 2.3.

Chapter 3: Client Benefits and Eligibility

Changed 25 TAC 38.16 to 26 TAC 351.16.

Chapter 4: Prior Authorizations and Authorizations

Changed 25 TAC 38.16 to 26 TAC 351.16.

Chapter 7: Appeals and Administrative Review

Changed 25 TAC 38.10 and 38.13 to 26 TAC 351.10 and 351.13.

Chapter 8: Advanced Practice Registered Nurse (APRN [NP/CNS])

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 9: Ambulance

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 10: Augmentative Communication Devices (ACDs)

Changed 25 TAC 38.6 to 26 TAC 351.6 in section 10.1.

Chapter 11: Blood Pressure Monitoring and Devices

Changed 25 TAC 38.6 to 26 TAC 351.6 in section 11.1.

Chapter 12: Certified Registered Nurse Anesthetist (CRNA)

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 13: Certified Respiratory Care Practitioner (CRCP)

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 14: Dental

CSHCN Services Program Provider Manual Update for Restorative Dental Services

Information posted March 11, 2022

Added limitation statement for retainer arch procedure code D8680 to section 14.2.4.3, "Submitting Local Codes for Orthodontic Procedures."

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Removed statement, "Restorations do not require prior authorization except for inlay or onlay restorations and crowns (single restorations only) in excess of four in a lifetime by any provider," from section 14.2.6.4, "Restorations."

Chapter 15: Diabetic Equipment and Supplies

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 16: Diagnostic Radiology Services

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 17: Durable Medical Equipment (DME)

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 18: Expendable Medical Supplies

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 20: Hearing Services

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 21: Home Health Services

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 22: Home Health (Skilled Nursing) Care

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 23: Hospice

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 24: Hospital

Changed 25 TAC 38.6 and 38.10 to 26 TAC 351.6 and 351.10.

Chapter 25: Laboratory Services

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 26: Medical Nutrition Services

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 27: Neurostimulators and Neuromuscular Stimulators

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 28: Orthotic and Prosthetic Devices

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 29: Outpatient Behavioral Health

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 30: Physical Medicine and Rehabilitation

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 31: Physician

First Quarter 2022 HCPCS Updates for the CSHCN Services Program

Information posted April 1, 2022

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 32: Physician Assistant (PA)

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 33: Prescribed Pediatric Extended Care Centers

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 34: Radiation Therapy Services

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 35: Renal Dialysis

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 36: Respiratory Equipment and Supplies

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 37: Speech-Language Pathology (SLP) Services

Changed 25 TAC 38.6 to 26 TAC 351.6.

Chapter 38: Telecommunication Services

Updated per TAC rule changes. Title 25 moved to 26 and DSHS Chapter 38 changed to HHSC Chapter 351.6 for Providers.

Chapter 40: Vision Services

Changed 25 TAC 38.6 to 26 TAC 351.6.

April 2022 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

Updated holiday calendar in section 5.1.8.

Chapter 14: Dental

Update to TMPPM and CSHCN Services Program Provider Manual for Dental Procedure Code D2951

Information posted February 11, 2022

Chapter 25: Laboratory Services

QW Modifier Required for Procedure Code 87801

Information posted February 11, 2022

Chapter 31: Physician

Update to Age and Diagnosis Restrictions for Injection Drugs for the CSHCN Services Program

Information posted March 18, 2022

March 2022 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 2: Provider Enrollment and Responsibilities

Coming Soon: TMHP Provider Enrollment and Management Systems (PEMS)
Information posted November 5, 2021

Chapter 24: Hospital

Changed inpatient rehabilitation facility/unit to inpatient hospital in section 24.3.1.4.1.

Chapter 27: Neurostimulators and Neuromuscular Stimulators

Prior Authorization Criteria for Surgical Implantation of HNS Effective March 1, 2022 for the CSHCN Services Program
Information posted December 30, 2021

February 2022 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

Removed 2020 authorization deadline calendar, and added 2022 authorization calendar to section 5.1.8.

Chapter 8: Advanced Practice Registered Nurse (APRN [NP/CNS])

Coming Soon: TMHP Provider Enrollment and Management Systems (PEMS)
Information posted November 5, 2021

Chapter 14: Dental

HCPCS Special Bulletin
Information posted December 30, 2021

Limited Orthodontic Treatment Will Become a Benefit of the CSHCN Services Program on January 1, 2022
Information posted December 30, 2021

Chapter 18: Expendable Medical Supplies

HCPCS Special Bulletin
Information posted December 30, 2021

Chapter 19: Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)

Coming Soon: TMHP Provider Enrollment and Management Systems (PEMS)
Information posted November 5, 2021

Limited Orthodontic Treatment Will Become a Benefit of the CSHCN Services Program on January 1, 2022
Information posted December 30, 2021

Chapter 20: Hearing Services

HCPCS Special Bulletin
Information posted December 30, 2021

Chapter 25: Laboratory Services

HCPCS Special Bulletin
Information posted December 30, 2021

Chapter 31: Physician

Coming Soon: TMHP Provider Enrollment and Management Systems (PEMS)
Information posted November 5, 2021

HCPCS Special Bulletin
Information posted December 30, 2021

Chapter 32: Physician Assistant (PA)

Coming Soon: TMHP Provider Enrollment and Management Systems (PEMS)
Information posted November 5, 2021

Chapter 33: Prescribed Pediatric Extended Care Centers

Coming Soon: TMHP Provider Enrollment and Management Systems (PEMS)
Information posted November 5, 2021

Chapter 40: Vision Services

HCPCS Special Bulletin
Information posted December 30, 2021

January 2022 CSHCN Release Notes

Chapter

Related Articles and Notes

Chapter 2: Provider Enrollment and Responsibilities

Replaced incorrect FSS Enrollment hyperlink with updated link.

Coming Soon: TMHP Provider Enrollment and Management System (PEMS)
Information posted November 5, 2021