Tag - Therapy

Provider Alert! COVID-19 Monoclonal Antibody Therapy Procedure Code Update

Date: September 20, 2021 Attention: All Providers Subject: COVID-19 Monoclonal Antibody Therapy Procedure Code Update Effective Date for procedure code M0243 is July 30, 2021 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: Texas Children’s Health Plan would like to inform network providers that Texas Medicaid [...]

Provider Alert!

Provider Alert! Therapy Prior Authorization Update

Date: July 29, 2021 Attention: All Providers Effective Date: August 1, 2021 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: Texas Children’s Health Plan (TCHP) would like to inform providers of updated TCHP prior authorization requirements for therapy services. How this impacts providers: Requests for acute [...]

Provider Alert!

Provider Alert! Speech, Physical, and Occupational Therapy Prior Authorization Update

Date: June 23, 2021 Attention: Therapy and Primary Care Providers Effective Date: June 23, 2021 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: Texas Children’s Health Plan (TCHP) would like to inform providers of updated TCHP prior authorization requirements. How this impacts providers: Effective June 23, 2021, [...]

Provider Alert!

Provider Alert! Prior Authorization Re-certification Requests Submission for Texas Medicaid

Date: January 7, 2021 Attention: Therapy Providers Effective Date: October 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: Texas Children’s Health Plan (TCHP) aligns with the guidance on prior authorization (PA) recertification requests. In compliance with House Bill 3041 of the 86th Texas [...]

Provider Alert!

Provider Alert! Initial specialty therapy evaluations no longer require an authorization but do require current Texas Health Steps checkup or attestation

Date: September 19, 2019 Attention: All Providers Subject:  Amended:  Initial and Ongoing Specialty Therapy Treatment- Current Texas Health Steps Checkup or Attestation required Effective Date: September 19, 2019 Call to action: Initial specialty therapy (occupational, physical, speech therapy) evaluations do not require prior authorization effective September 1, 2019. However, a current Texas Health Steps checkup performed in the last 12 months or a current well checkup attestation is required for ongoing specialty therapy lasting for greater than 60 days. How this [...]

Key Changes to TCHP Therapy Authorization Guidelines

When services were not prior authorized by Texas Children’s Health Plan, (through another MCO or TMHP) the authorization request must include: A copy of the previously approved authorization letter. All of the documentation that was sent in the original authorization request to the previous MCO or TMHP, including any physician orders that were used to determine the start of care. If the services requested do not meet TCHP criteria, the services will be honored for the shorter of 90 days or until [...]

Provider Alert!

Provider Alert! Therapy Wait List

Subject:  Therapy Providers Effective 1/15/2018, HHSC formally required MCOs to report on access issues specific to all therapy modalities (PT, OT, ST). In the future, if Texas Children’s Health Plan (TCHP) should receive a member complaint specific to access to care, TCHP will follow-up with each therapy provider. If a wait list is identified, each provider will be required to submit detailed information for each member waiting for care. The information will need to be populated in a specified template, [...]

Provider Alert!

Provider Alert! Changes to physical, occupational and speech therapy benefits for all ages

Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT) and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please visit the TMHP website to review for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT and ST services Procedure codes end-dating August 31, 2017 Required modifiers Claims filing changes Clarification to benefits Providers may refer to the current Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational [...]