Provider Alert! Texas Medicaid Provider Procedures Manual (TMPPM) Updates for Obstetric Services

Updated on: December 17, 2021

Attention: Obstetric Care Providers

Effective Date: July 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: Effective July 1, 2021, The Texas Medicaid and Healthcare Partnership (TMHP) updated the Texas Medicaid Provider Procedures Manual, Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook, section 4.1, “Services, Benefits, Limitations, and Prior Authorization,” and Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.7.3, “Anesthesia for Labor and Delivery.” The updates are outlined in the following section.

How this impacts providers: For section 4.1 Services, Benefits, Limitations, and Prior Authorization of the TMPPM, the following statement will be updated to include neuraxial labor analgesia:

• Medicaid may reimburse only one delivery of Cesarean section procedure code per client in a seven-month period; reimbursement includes multiple births.
• Delivering physicians who perform regional anesthesia or nerve block do not receive additional reimbursement because these charges are included in the reimbursement for the delivery except when it is decided a Cesarean delivery is required following neuraxial labor analgesia.
• Procedure codes 01960 and 01967 will be limited to once every 210 days and 01967 may be reimbursed separately with Cesarean procedure codes 59514, 59515, 59620, and 59622.
• UPDATE December 17, 2021: Effective for dates of service on or after July 1, 2021, Neuraxial labor analgesia/anesthesia code 01967 is not separately payable from vaginal delivery codes 59409, 59410, 59612, and 59614.

Next steps for providers: Providers should share this communication 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.