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2023 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 2022, see the 2022 Release Notes.  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 2022, see the 2022 Release Notes.

2023 December CSHCN Release Notes
ChapterRelated Articles and Notes
Chapter 3: Client Benefits and EligibilityFixed URL in section 3.1.1.
Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

TMHP to Update Place of Service Code 55

Information posted November 2, 2023

Chapter 9: Ambulance

TMHP to Update Place of Service Code 55

Information posted November 2, 2023

Chapter 11: Blood Pressure Monitoring and DevicesAdded new diagnoses to section 11.2.1.3.
Chapter 14: Dental

Benefit for Caries Arresting Medicament to Change for the CSHCN Services Program Effective December 1, 2023

Information posted October 27, 2023

Chapter 15: Diabetic Equipment and Supplies

CSHCN Services Program Provider Manual Update for Continuous Glucose Monitors

Information posted October 13, 2023

Chapter 24: Hospital

CSHCN Services Program Benefit of Renal Transplants Updated Effective December 1, 2023

Information posted October 13, 2023

Chapter 31: Physician

Reimbursement Rate Updates for Drug Procedure Code C9155 Effective October 1, 2023

Information posted October 20, 2023

Reimbursement Rate Updates for Drug Procedure Codes J7214 and J9345 Effective October 1, 2023

Information posted October 16, 2023

 

2023 November CSHCN Manual Release Notes
ChapterRelated Articles and Notes
Chapter 3: Client Benefits and EligibilityUpdated URL in section 3.1.2.
Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement

TMHP to Update Place of Service Code 10

Information posted September 22, 2023

Chapter 10: Augmentative Communication Devices (ACDs)Updated URL in section 10.3.
Chapter 11: Blood Pressure Monitoring and Devices

2024 International Classification of Diseases, Tenth Revision (ICD-10) Special Bulletin

Information posted September 28, 2023

Chapter 15: Diabetic Equipment and Supplies

2024 International Classification of Diseases, Tenth Revision (ICD-10) Special Bulletin

Information posted September 28, 2023

Chapter 25: Laboratory Services

2024 International Classification of Diseases, Tenth Revision (ICD-10) Special Bulletin

Information posted September 28, 2023

Chapter 27: Neurostimulators and Neuromuscular Stimulators

2024 International Classification of Diseases, Tenth Revision (ICD-10) Special Bulletin

Information posted September 28, 2023

Chapter 31: Physician

2024 International Classification of Diseases, Tenth Revision (ICD-10) Special Bulletin

Information posted September 28, 2023

Removed diagnosis code tables for procedure codes 94640, 94644, and 94645 as these codes are no longer diagnosis restricted.

Added additional diagnosis codes D8481, D84821, D84822, and D8489 for procedure codes 94642 and J2545.

Added additional diagnosis codes to the tables for procedure codes J7605, J7608, J7622, J7622, J7631, J7639, J7644, and J7682.

Added diagnosis code N130 to the table of section 31.2.21, "Extracorporeal Shock Wave Lithotripsy (ESWL)."

Added diagnosis codes C563 and C7963 to the table of section 31.2.26.8, "Bevacizumab."

Added diagnosis code C847A to the table of payable diagnoses in section 31.2.26.10, "Epirubicin Hydrochloride."

Added diagnosis codes C563, C7963, and C847A to the limitations column for procedure code J9207 in section 31.2.26.5, "Injection Procedure Codes."

Added diagnosis codes C563, C7963, and C847A to the table of section 31.2.26.18, "Trastuzumab."

Added diagnosis codes M1909, M1919, and M1929 to the table of section 31.2.26.19, "Triamcinolone Acetonide."

Added diagnosis codes I2720, I2721, I2722, I2723, I2724, I2729, I2783, and P2930 to the limitations column for procedure code J1325 in section 31.2.26.5, "Injection Procedure Codes."

Added diagnosis codes K5650, K5651, K5652, K56600, K56601, K56609, K56690, K56691, K56699, K9130, K9131, and K9132 to the limitations column for procedure code J2323 in section 31.2.26.5, "Injection Procedure Codes."

Added diagnosis codes D6800, D6801, D68020, D68021, D68022, D68023, D68029, D6803, D6804, D6809, D75821, D75822, D75828, D75829, D75838, and D7584 to the limitations column for procedure code J7197 in section 31.2.26.5, "Injection Procedure Codes."

Added diagnoses M060A, M068A, M45A0, M45A1, M45A2, M45A3, M45A4, M45A5, M45A6, M45A7, M45A8, and M45AB to the table of section 31.2.26.14, "Infliximab, Inflectra, and Renflexis."

Replaced broken link in section 31.2.25.13, "Respiratory Syncytial Virus (RSV) Prophylaxis" to the Vendor Drug website.

 

October 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 1: TMHP and HHSC Contact Information

TMHP Live Chat Support Implementing September 5, 2023

Information posted July 21, 2023

Chapter 4: Prior Authorizations and AuthorizationsReplaced broken hyperlink for CSHCN PA for Medical Nutritional Products.
Chapter 13: Certified Respiratory Care Practitioner (CRCP)

Reminder: TMHP Provider Enrollment and Management System (PEMS)

Information posted September 1, 2023

Chapter 21: Home Health ServicesReplaced broken prior authorization form hyperlink in section 21.3.5.1, "Prior Authorization for Medical Nutritional Counseling Services."
Chapter 26: Medical Nutrition Services

Reminder: TMHP Provider Enrollment and Management System (PEMS)

Information posted September 1, 2023

Chapter 31: Physician

Reminder: TMHP Provider Enrollment and Management System (PEMS)

Information posted September 1, 2023

Procedure Code J1559 to Become a Benefit of CSHCN

Information posted July 25, 2023

 

September 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 14: Dental

Benefits for CSHCN Dental Preventive Services to Change September 1, 2023

Information posted August 25, 2023

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

Benefits for CSHCN Dental Preventive Services to Change September 1, 2023

Information posted August 25, 2023

Chapter 25: Laboratory Services

Removed procedure codes 80305, 80306, and 80307 and their relationships from table in section 25.2.5.1.

Updated language for submitting CLIA certification in section 25.1.1.

Chapter 35: Renal Dialysis

Renal Dialysis Benefits to Change for CSHCN September 1, 2023

Information posted July 14, 2023

August 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 15: Diabetic Equipment and Supplies

Diabetic Equipment and Supplies Benefits to Change for CSHCN Services Program August 1, 2023

Information posted June 16, 2023

Chapter 31: Physician

Second Quarter 2023 HCPCS Updates for the CSHCN Services Program

Information posted June 31, 2023

July 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 1: TMHP and HHSC Contact InformationUpdated TMHP address in section 1.1.2.
Chapter 3: Client Benefits and EligibilityChanged TMHP address in section 3.4.
Chapter 4: Prior Authorizations and AuthorizationsChanged TMHP address in sections 4.3, 4.3.2, and 4.4.10.
Chapter 5: Claims Filing, Third-Party Resources, and ReimbursementChanged TMHP address in sections 5.1.1 and 5.2.7.
Chapter 6: Remittance and Status (R&S) ReportsChanged TMHP address in section 6.1.4.4
Chapter 7: Appeals and Administrative ReviewChanged TMHP address in section 7.3.3.
Chapter 24: HospitalChanged TMHP address in section 24.2.
Chapter 31: Physician

Removed the limitation language that requires procedure code 99358 to be billed with appropriate physician E/M code for non-face-to-face prolonged services. Added limitation language regarding non-face-to-face prolonged services less than 30 minutes.

Removed one per day limitation statements for procedure codes 96372 and 96374 in sections 31.2.25.6, "Vaccine Administration," and 31.2.26.2, "Injection Administration Billed by a Physician."

Chapter 37: Speech-Language Pathology (SLP) ServicesUpdated language in 37.2.1.
June 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 5: Claims Filing, Third-Party Resources, and ReimbursementUpdated POS table to match national POS codes in the eOPM.
Chapter 14: Dental

Limitation Criteria for First Dental Home Examinations Added to TMPPM and CSHCN Services Program Provider Manuals

Information added April 14, 2023

Some Ambulatory Surgical Center Procedure Codes No Longer Benefits for the CSHCN Services Program Effective June 1, 2023

Information posted April 28, 2023

Chapter 21: Home Health Services

Home Health Benefits for the CSHCN Services Program to Change on June 1, 2023

Information posted April 14, 2023

Chapter 31: Physician

Update to Physician Chapter in CSHCN Services Program Provider Manual

Information posted May 30, 2023

Some Ambulatory Surgical Center Procedure Codes No Longer Benefits for the CSHCN Services Program Effective June 1, 2023

Information posted April 28, 2023

Chapter 33: Prescribed Pediatric Extended Care Centers

Home Health Benefits for the CSHCN Services Program to Change on June 1, 2023

Information posted April 14, 2023

May 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 14: Dental

Update to CSHCN Services Program Provider Manual for Some Dental Procedure Codes Effective May 1, 2023

Information posted March 17, 2023

Updated the benefit imitations for procedure code D4381 in section 14.2.6.6, "Periodontics."

Chapter 20: Hearing Services

Update to CSHCN Services Program Provider Manual for Hearing Aid Services Prior Authorization Language

Information posted March 17, 2023

Chapter 25: Laboratory ServicesUpdated CLIA certification information in section 25.1.1.
Chapter 31: Physician

First Quarter 2023 HCPCS Updates for the CSHCN Services Program

Information posted March 30, 2023

Revised website link updated as www.aasm.org.

April 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 3: Client Benefits and EligibilityUpdated PAF link throughout handbook to be correct link and made language changes to update associated website from TMHP to HHS.
Chapter 14: Dental

Update to TMPPM and CSHCN Services Program Provider Manual for Dental Procedure Code D2910

Information posted February 10, 2023

Chapter 16: Diagnostic Radiology ServicesRemoved procedure codes Q9956 and Q9957 from section 16.2.10.1.
Chapter 25: Laboratory ServicesUpdated limitation for procedure code 88273 in section 25.2.5.2.
Chapter 31: Physician

2022 ICD-10 Special Bulletin

For consistency and accuracy, removed and updated some benefit limitation statements in section 31.2.18.6, "Prolonged Physician Services."

March 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 17: Durable Medical Equipment (DME)

Update to CSHCN Services Program Provider Manual: Prior Authorization Requirements about Special Needs Car Seats

Information posted January 27, 2023

February 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 14: Dental

2023 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 30, 2022

Chapter 15: Diabetic Equipment and Supplies

2023 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 30, 2022

Chapter 16: Diagnostic Radiology Services

2023 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 30, 2022

Chapter 20: Hearing Services

2023 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 30, 2022

Chapter 25: Laboratory Services

2023 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 30, 2022

Chapter 31: Physician

2023 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 30, 2022

Chapter 35: Renal Dialysis

2023 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 30, 2022

Chapter 38: Telecommunication Services

2023 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 30, 2022

Chapter 40: Vision Services

2023 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin

Information posted December 30, 2022

 

January 2023 CSHCN Provider Manual Release Notes
ChapterRelated Articles and Notes
Chapter 4: Prior Authorizations and AuthorizationsUpdated the filing deadline calendars in section 4.1.
Chapter 5: Claims Filing, Third-Party Resources, and ReimbursementUpdated the holiday calendar in section 5.1.8; Updated the claims filing deadline calendar links in sections 5.1.8 and 5.5.
Chapter 7: Appeals and Administrative ReviewUpdated the Authorization Filing Calendar in section 7.3.
Chapter 31: Physician

Evoked Response Test and Neuromuscular Procedure Benefits to Change for the CSHCN Services Program January 1, 2023

Information posted November 11, 2022

Injection Procedure Codes J2020 and J2250 Now a Benefit of the CSHCN Services Program

Information posted December 6, 2022