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2021 TMPPM Release Notes

Last updated on 8/31/2021

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

For changes that were made in 2020, see the 2020 Release Notes.

September TMPPM Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 6: Claims Filing

Coming Soon: TPI Number to be Removed From Prior Authorization Forms and Claim Forms, Effective September 1, 2021
Information posted July 20, 2021

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Diabetic Equipment and Supplies Benefits to Change for Texas Medicaid September 1, 2021
Information posted July 16, 2021

Inpatient and Outpatient Hospital Services Handbook

Maternal Level of Care Designation Required for Hospital Providers Rendering Inpatient and Outpatient Services
Information posted August 31, 2021

Lung Cancer Screening Benefits to Change for Texas Medicaid Effective September 1, 2021
Information posted July 16, 2021

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Intraoperative Neurophysiology Monitoring Performed in Addition to Evoked Potential Tests for Texas Medicaid
Information posted August 13, 2021

Additional Testing Time for Ingestion Challenge Tests to Become a Benefit of Texas Medicaid
Information posted July 16, 2021

Outpatient Drug Services Handbook

Age Restriction Removal for Ultomiris for Treatment of Paroxysmal Nocturnal Hemoglobinuria (PNH)
Information posted July 2, 2021

Prior Authorization Criteria Added for Casimersen (Amondys 45) Effective September 1, 2021
Information posted July 16, 2021

Vision and Hearing Services Handbook

Vision Services-Nonsurgical Benefits to Change Effective September 1, 2021
Information posted July 16, 2021

 

August 2021 TMPPM Release Notes

Handbook

Related Articles and Notes

Children’s Services Handbook: Appendix B: Immunizations

Second Quarter 2021 HCPCS Updates for Texas Medicaid
Information posted June 29, 2021

Children’s Services Handbook: Appendix F: THSteps Quick Reference Guide

Second Quarter 2021 HCPCS Updates for Texas Medicaid
Information posted June 29, 2021

Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)

Second Quarter 2021 HCPCS Updates for Texas Medicaid
Information posted June 29, 2021

Updated limitation language for some procedure codes within section 2.5.1.1.9, "Non-Face-to-Face Care Plan Oversight."

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Second Quarter 2021 HCPCS Updates for Texas Medicaid
Information posted June 29, 2021

Updated limitation language for panniculectomy and abdominoplasty prior authorization.

Changed the word "same" to "any" in the statement below the table of section 9.2.49, "Osteopathic Manipulative Treatment (OMT)."

Edits made to statements, procedure code 29799 added to table, and some statements and tables removed from section 9.2.18, "Casting, Splinting, and Strapping."

Outpatient Drug Services Handbook

Second Quarter 2021 HCPCS Updates for Texas Medicaid
Information posted June 29, 2021

Removed duplicate information from section 1.1, "About the Vendor Drug Program." Edits made to statements in section 1.2, "Pharmacy Enrollment," 9.2, "Vitamin and Mineral Products," and 11.6 "Free Delivery of Medicaid Prescriptions." Added subheader to 9.1, "Formulary Search." Edits and additional language about Makena added to section 9.4.4.4, "Makena." In section 9.5.1, "Schedule and Forms" header title, edits and new section added with information about forms for Medicaid and Managed Care.

 

July 2021 TMPPM Release Notes

Handbook

Related Articles and Notes

Children’s Services Handbook: THSteps Dental services (Section 4)

TMPPM Children’s Services Handbook Update for Texas Health Steps Dental Services
Information posted May 14, 2021

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook

TMPPM Updates for Obstetric Services Effective July 1, 2021
Information posted May 14, 2021

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

TMPPM Updates for Obstetric Services Effective July 1, 2021
Information posted May 14, 2021

Removed procedure code J2810 from the table in section 9.3.2.1, "Additional Payable Procedure Codes," under the column "Injections/Medications."

Outpatient Drug Services Handbook

Additional Diagnosis Code Added for Procedure Code J0585
Information posted May 21, 2021

June 2021 TMPPM Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 1: Provider Enrollment and Responsibilities

Updated facility enrollment instructions to align with PEP instructions.

Volume 1: Section 4: Client Eligibility

Healthy Texas Women Medicaid 1115 Demonstration Waiver Effective March 20, 2021
Information posted March 23, 2021

Children’s Services Handbook: Appendix F: THSteps Quick Reference Guide

Developmental Screening and Mental Health Screening Tools Added for Texas Health Steps
Information posted April 16, 2021

Updated webpage links under the following columns: Texas Health Steps Website, Case Management for Children and Pregnant Women, and Medical Transportation Program (MTP).

Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)

Changed DSHS to HHSC in the last statement of section 5.3.10, THSteps Medical Checkups Periodicity Schedule.

Developmental Screening and Mental Health Screening Tools Added for Texas Health Steps
Information posted April 16, 2021

Children’s Services Handbook: THSteps Dental services (Section 4)

Changed radiograph requirement limitation for procedure code D7962 from PXR to PHO in the table of section 4.2.20, "Oral and Maxillofacial Surgery Services."

Update to 2021 HCPCS Bulletin and TMPPM for Texas Health Steps Dental Procedure Codes D7961 and D7962
Information posted April 16, 2021

Added removable prosthodontic procedure codes that require prior authorization to the bulleted list in section 4.2.29, "Mandatory Prior Authorization."

Healthy Texas Women (HTW) Program Handbook

New HTW Provider Certification Requirements
Information posted April 26, 2021

Outpatient Drug Services Handbook

First Quarter 2021 HCPCS Updates for Texas Medicaid
Information posted March 29, 2021

Prior Authorization Criteria Updated for Omalizumab (Xolair) Effective June 1, 2021
Information posted April 16, 2021

Ferric Derisomaltose a Benefit of Texas Medicaid Effective April 1, 2021
Information posted May 14, 2021

Indications for Abatacept (Orencia) to Change for Texas Medicaid June 1, 2021
Information posted April 16, 2021

Pegfilgrastim-apgf (Nyvepria) a Benefit of Texas Medicaid Effective April 1, 2021
Information posted May 28, 2021

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook

Added a reference in section 7.1 referring to section 2.8 for additional information for home health agencies.

 

May 2021 TMPPM Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 6: Claims Filing

Updated broken vendor drug links in sections 6.3.4.1 and 6.3.4.2.

Added language regarding drug rebates to section 6.3.4.3, "Drug Rebate Program."

Children’s Services Handbook: THSteps Dental services (Section 4)

In section 4.2.12, “Periodicity for THSteps Dental Services,” revised periodicity schedule name to align with the American Academy of Pediatric Dentistry (AAPD) name change.

Updated broken website link in Section 4, “Texas Health Steps (THSteps) Dental.”

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Update to TMPPM for Respiratory Equipment for Clients Not Meeting Required Criteria
Information posted March 5, 2021

Listed out all replacement battery procedure codes in section 2.2.12.6, "External Insulin Pump and Supplies," and related supply procedure codes in section 2.2.23.8, "Continuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RAD) including Bi-Level PAP."

Outpatient Drug Services Handbook

Prior Authorization Criteria for Onasemnogene Abeparvovec-xioi (Zolgensma) will be Updated for Texas Medicaid Effective May 1, 2021
Information posted March 26, 2021

Removed procedure code J1560 from the table of section 7.38, "Immune Globulin."

April 2021 Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 1: Provider Enrollment and Responsibilities

Revised provider enrollment instructions for online and paper applications in sections 1.1.3, "Enrollment," and 1.1.4, "Paper Application Enrollment."

Volume 1: Section 7: Appeals

Updated the express mail only address in section 7.3.3, "Utilization Review Appeals."

New TMHP Contact Page Feature for Submitting Complaints in 2021
Information posted January 29, 2021

Children’s Services Handbook: Appendix B: Immunizations

Removed procedure code 90650 from the table in appendix B.3.3, "Immunizations (Vaccines/Toxoids)."

Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)

Removed procedure code 90650 from the table in section 5.3.11.3, "Immunizations."

Clinics and Other Outpatient Facility Services Handbook

Removed procedure code J1840 from the table of section 8.2.2, "Ancillary Services."

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook

Removed the phone method for prior authorization requests from the language in section 4.1.8, "Obstetrics Ultrasound."

Healthy Texas Women (HTW) Program Handbook

Removed procedure code 90650 from section 2.3, "Services, Benefits, Limitations, and Prior Authorization."

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Removed procedure codes J0715, J1840, and J1850 in the table of section 9.3.2.1, "Additional Payable Procedure Codes."

Removed procedure code 90650 from the tables of sections 9.2.34.1, "Administration Fee," 9.2.35.2, "Vaccine and Toxoid Procedure Codes," and 9.2.36, "Immunizations for Clients Who Are 21 Years of Age and Older."

Outpatient Drug Services Handbook

NDC example statement added to section 6, National Drug Code (NDC). Revised the list for detailed filter searches, and added information about the Epocrates drug information system in section 9.1, “Formulary Search.” Updated website information for VDP Product Searches in section 9.2, “Vitamin and Mineral Products,” and section 9.3, “Home Health Supplies.” Updated website information, removed reference statements related to LARC, and VDP Formulary Search. Removed "Formulary" from statement "To identify drugs that require 90 percent utilization, refer to the VDP Formulary Search and select the “90% Utilization” filter. The returned results will include only those drugs that meet this requirement," in section 10.4, “Requirements for Early Refills.”

Updated age restrictions for procedure code J1303 in section 7.62, "Ravulizumab-cwvz (Ultomiris)."

Removed procedure code J9212 and some minor edits and revisions within section 7.43, "Interferon."

Telecommunication Services Handbook

Telemonitoring Benefits to Change for Texas Medicaid March 1, 2021
Information posted February 23, 2021

 

March 2021 Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 5: Fee-for-Service Prior Authorizations

Added prior authorization language to section 5.4, “Submitting Prior Authorization Forms.”

Behavioral Health and Case Management Services Handbook

Effective March 1, 2021, Benefits for Medication Assisted Treatment Services to Change for Texas Medicaid
Information posted January 15, 2021

Effective March 1, 2021, Benefits for Peer Specialist Services to Change for Texas Medicaid
Information posted January 15, 2021

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Added Diagnosis Codes for Nutritional Products-CCP
Information posted January 29, 2021

Effective March 1, 2021, Immobilized Lipase Cartridges to Become a Benefit of Texas Medicaid
Information posted December 31, 2020

Healthy Texas Women (HTW) Program Handbook

Procedure Code 94617 to Become a Benefit for Healthy Texas Women Plus
Information posted January 29, 2021

Effective March 1, 2021, Procedure Codes 77063 and G0279 to Become Benefits of Texas Medicaid and HTW
Information posted January 15, 2021

Inpatient and Outpatient Hospital Services Handbook

Effective March 1, 2021, Colorectal Cancer Screening Benefit Criteria to Change for Texas Medicaid
Information posted January 15, 2021

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Effective March 1, 2021, Benefits for Wound Care Management Services to Change for Texas Medicaid
Information posted January 15, 2021

Effective March 1, 2021, Procedure Codes 77063 and G0279 to Become Benefits of Texas Medicaid and HTW
Information posted January 15, 2021

New ICD-10 COVID-19 Diagnosis Code Updates Effective January 1, 2021
Information posted December 30, 2020

Effective March 1, 2021, Colorectal Cancer Screening Benefit Criteria to Change for Texas Medicaid
Information posted January 15, 2021

Effective March 1, 2021, Medical Physics Consultations to Become Benefits of Texas Medicaid
Information posted December 31, 2020

Outpatient Drug Services Handbook

Prior Authorization Criteria for Viltolarsen (Viltepso) Effective March 1, 2021
Information posted February 12, 2021

 

February 2021 Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 5: Fee-for-Service Prior Authorizations

Added prior authorization language to section 5.4, "Submitting Prior Authorization Forms."

Ambulance Services Handbook

Added language regarding ambulance provider claims to section 2.4.3, "Medicare and Medicaid Coverage."

Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)

2021 HCPCS Special Bulletin
Information posted January 2021

Children’s Services Handbook: THSteps Dental services (Section 4)

2021 HCPCS Special Bulletin
Information posted January 2021

Updated statement in section 4.2.5, Children’s Medicaid Dental Plan Choices to clarify the number of dental MCOs.

Removed statement about direct and indirect pulp caps from section 4.2.3.9, "Therapeutic Services." Revised and updated language for direct and indirect pulp caps and removed limitation statement for pulp caps in the table of section 4.2.16, "Endodontics Services."

Clinics and Other Outpatient Facility Services Handbook

2021 HCPCS Special Bulletin
Information posted January 2021

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook

2021 HCPCS Special Bulletin
Information posted January 2021

Added note statement about 42 day global period to section 4.1.14, "Antenatal and Postnatal Care Visits."

Healthy Texas Women (HTW) Program Handbook

2021 HCPCS Special Bulletin
Information posted January 2021

Inpatient and Outpatient Hospital Services Handbook

2021 HCPCS Special Bulletin
Information posted January 2021

Medicaid Managed Care Handbook

Added prior authorization language to section 2.8, "Authorizations for Managed Care Services."

 

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

2021 HCPCS Special Bulletin
Information posted January 2021

Added note statement about 42 day global period to section 9.2.69.6, "Global Fees."

Outpatient Drug Services Handbook

2021 HCPCS Special Bulletin
Information posted January 2021

Prior Authorization Criteria for Mepolizumab (Nucala) to be Updated for Texas Medicaid Effective February 1, 2021
Information posted December 18, 2020

Update to TMPPM Outpatient Drug Services Handbook for Blood Factor Products
Information posted December 18, 2020

Radiology and Laboratory Services Handbook

2021 HCPCS Special Bulletin
Information posted January 2021

Telecommunication Services Handbook

2021 HCPCS Special Bulletin
Information posted January 2021

Vision and Hearing Services Handbook

2021 HCPCS Special Bulletin
Information posted January 2021

 

January 2021 Release Notes

Handbook

Related Articles and Notes

Volume 1: Section 1: Provider Enrollment and Responsibilities

Added clinical trial information to section 1.12, "Texas Medicaid Limitations and Exclusions."

Replaced TMHP website with HHS website to direct providers to the Provider Marketing Guidelines.

Volume 1: Section 6: Claims Filing

Balance Billing QMB and MQMB Clients
Information posted May 15, 2015

New Section for SHARS in R&S Reports
Information posted November 5, 2020

Updated filing deadline calendars throughout section 6.

Children’s Services Handbook: THSteps Dental services (Section 4)

Changed word "panorex" to "panoramic" in the limitation section for procedure code D0330 section 4.2.3.7, "Diagnostic Services."

Removed statement, "All fees for tooth restorations include local anesthesia and pulp protective media, where indicated, without additional charges. These services are considered part of the restoration" in section 4.2.3.9, "Therapeutic Services."

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Update to the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook
Information posted December 18, 2020

Added procedure code E1012 to the table in section 2.2.17.30, "Procedure Codes and Limitations for Mobility Aids."

Inpatient and Outpatient Hospital Services Handbook

Added reference to HHS website for more information on Potentially Preventive Events (PPE).

Outpatient Drug Services Handbook

Prior Authorization Criteria for Esketamine (Spravato) to be Updated for Texas Medicaid Effective January 1, 2021
Information posted November 13, 2020