Provider Alert! Prosthetics Codes Prior Authorization Requirements
Attention: Prosthetics, DME providers, orthopedists, podiatrists, PCPs
Effective Date: June 3, 2020
Call to action: Texas Children’s Health Plan (TCHP) aligns with Texas Medicaid Provider Procedures Manual (TMPPM) and requires prior authorization for prosthetics procedures codes.
How this impacts providers: Provider offices should utilize the Standard Prior Authorization Form for prosthetics.
References:
TCHP Prior Authorization Requirements
TCHP Prosthetics Guidelines
Next steps for providers: Providers should reference the prosthetic procedure codes according to TMPPM section 2.2.19.2 Prior Authorization and Documentation Requirements.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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