Provider Alert! Ambulatory and Long-Term Electroencephalogram Benefits Changing for Texas Medicaidtcph
Attention: All 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) would like to inform providers that effective for dates of service on or after October 1, 2020, ambulatory and long-term electroencephalogram (EEG) benefits will change for Texas Medicaid. The time increment for each unit will no longer be 24 hours. Ambulatory and long-term EEG monitoring is a covered benefit for clients in whom a seizure diathesis is suspected but not defined by history, physical, and resting EEG. Established Medicaid coverage for ambulatory EEG is limited to three units (each unit 24 hours) for each physician for the same client per six months when medically necessary.
How this impacts providers: Time increments for each unit of the following procedure codes are defined in their respective descriptions.
*Procedure code 95700 (setup, patient education, and takedown) will be limited to 3 units per 6 months for each physician for the same client, in addition to the 3 units allowed for the procedure codes listed in the table above.
Resource: TMHP Notice
Next steps for providers: Providers should share the time increment change with their staff.
If you have any questions, please email Provider Network Management at: email@example.com.