Provider Alert! Updates to the Texas Medicaid Provider Procedures Manual

Attention: Radiologists, Cardiologists, Imaging Services, Ophthalmologists, Optometrists

Effective Date: August 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 Texas Medicaid Healthcare Partnership (TMHP) regarding the benefit criteria in the Medical and Nursing Specialists, Physicians and Physician Assistants Handbook and Vision and Hearing Services Handbook of the TMPPM.

Resources: Updates to the Texas Medicaid Provider Procedures Manual
TMPPM Diagnostic Doppler Sonography
TMPPM Eye Surgery Limitations

How this impacts providers: Updates to Medical and Nursing Specialists, Physicians and Physician Assistants Handbook:

• Section 9.2.26 Diagnostic Doppler Sonography changes:
  • Codes 93307, 93320, and 93321 will no longer need to be billed with code 93325 to be considered for reimbursement.
  • Code 93351 will be added to the table for code 93325 and has been added to Doppler echocardiography reimbursement.
  • Code 93325 for Doppler echocardiography color flow mapping must be billed with one of the following codes to be considered for reimbursement:
    • 76825, 76826, 76827, 76828, 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, or 93351
  • Section 9.2.46.6 Other Eye Surgery Limitations:
    • Code 67112 will no longer be a benefit.
    • Code 66990 may be reimbursed when procedure code 67113 has been paid to the same provider on the same date of service.
    • Codes 67335 and 67340 may be reimbursed when procedure codes 67320, 67331, 67332, or 67334 has been paid to the same provider on the same date of service.
    • The codes in Column A may only be reimbursed when at least on of the codes in Column B has been paid to the same provider for the same date of service:

The codes in Column A may only be reimbursed when at least one of the codes in Column B has been paid to the same provider for the same date of service

Update to Vision and Hearing Services Handbook

• Section 2.2.3.7 Limitations:
  • Code 92547 for electrical testing must be billed on the same date of service and the same provider as codes 92540, 92541, 92542, 92544, 92545, or 92546.

Resource: TMPPM Electrical Testing Limitations

Next steps for providers: Providers should follow this guidance and share it with their staff.

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.