Provider Alert! Prosthetics Codes Update
Effective Date: June 3, 2020
Attention: Prosthetics, DME providers, orthopedists, podiatrists, PCPs
Call to action: Texas Children’s Health Plan will now configure the prosthetics procedures codes to require prior authorization according to the Texas Medicaid Provider Procedures Manual (TMPPM). Currently, the only procedure codes on the prior authorization list are related to Breast Reconstruction.
How this impacts providers: Provider offices should utilize the Standard Prior Authorization Form for prosthetics that require a prior authorization:
https://www.texaschildrenshealthplan.org/for-providers/provider-resources/prior-authorization-information
Next steps for providers: Providers should reference the prosthetic procedure codes according to TMPPM section 2.2.19.2 Prior Authorization and Documentation Requirements:
http://www.tmhp.com/Manuals_HTML1/TMPPM/Current/index.html#t=TMPPM%2F2_DME_and_Supplies%2F2_DME_and_Supplies.htm&rhsearch=prosthetics&rhhlterm=prosthetics&rhsyns=%20
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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