Provider Alert! Updated reimbursement information for Inpatient Genetic Services
Attention: Geneticist
Effective Date: May 1, 2020
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: TCHP would like to inform you of a recent update to the reimbursement information for inpatient genetic service codes 99254 and 99255. Effective for dates of service on or after May 1, 2020, Texas Medicaid and Healthcare Partnership (TMHP) updated the Texas Medicaid Provider Procedures Manual (TMPPM) Medical and Nursing Specialists, Physicians, and Physicians Assistants Handbook, section 5.2.5, Genetic Evaluation and Counseling by a Geneticist. The update clarifies reimbursement for codes 99254 and 99255, which only allows one of the codes to be paid every three years. This is regardless of whether an office consultation has been reimbursed in the previous three years.
| Code | Description |
| 99254 | Inpatient consultation for a new or established patient, 80 minutes |
| 99255 | Inpatient consultation for a new or established patient, 110 minutes |
References:
Updates to TMPPM and CSHCN Services Program Provider Manual for Genetic Services Reimbursement Criteria for Procedure Codes 99254 and 99255
TMPPM section 5.2.5, Genetic Evaluation and Counseling by a Geneticist
How this impacts providers: Providers should become familiar with the updates to the reimbursement information.
Next steps for providers: Inform their staff of the reimbursement updates.
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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