Provider Alert! Reimbursement Reminder for Outpatient Surgical Procedure Codes

Provider Alert!

Provider Alert! Reimbursement Reminder for Outpatient Surgical Procedure Codes

Date: June 4, 2021

Attention: All Providers

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 provide information to providers that TCHP follows Health and Human Services Commission (HHSC) guidance for outpatient surgical procedure reimbursement. Payments for outpatient surgical procedure codes include medical devices/implants used for the procedure. This is in alignment with the Texas Medicaid Provider Procedures Manual (TMPPM), Inpatient and Outpatient Hospital Services Handbook, Section 5.4.2

Medical devices/implants are not reimbursed separately. Examples include, but are not limited to, screws, wires, mesh, etc.

Certain pieces of equipment may be reimbursed separately in conjunction with the surgical procedure. Examples of such reimbursable codes include the following;

Cochlear implant devices (L8614)
Implantable infusion pumps (E0782, E0783, E0786)
Neurostimulator devices (L8681, L8682, L8683, L8684, L8685, L8686, L8687 L8688, L8689, L8695, E0720, E0730, E0731, E0745, E0762, E0764)

Next steps for providers: Providers should share this update with their staff.

For additional information please refer to the TMPPM.

The Texas Medicaid fee schedule is available here: https://public.tmhp.com/FeeSchedules/OnlineFeeLookup/FeeScheduleSearch.aspx

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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