Tag - procedure code

Provider Alert!
14May

Provider Alert! Vaccine Services Procedure Code 90623 is Now Available Through TVFC

Date: May 14, 2024 Attention: All Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after April 1, 2024, vaccine services procedure code 90623 is now available through the Texas Vaccines for Children (TVFC) program for clients who are 10 years through 18 years of age. Note: Procedure codes for vaccines distributed by the Texas Vaccines for Children Program are processed as Informational on Texas Medicaid fee-for-service...

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Provider Alert!
07May

Provider Alert! Prior Authorization Update for Incontinence Supplies Procedure Code A6250

Date: May 7, 2024 Attention: All Providers Effective: April 10, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a prior authorization update for incontinence supplies procedure code A6250, skin sealants, protectants, moisturizers, and ointments, any type, any size. Procedure code A6250 is indicated to treat the following: Incontinence-associated dermatitis Effective April 10, 2024, prior authorization is required for procedure code A6250 for members 0-3 years of age. Providers can review prior authorization criteria and additional information regarding procedure code A6250...

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Provider Alert!
26Feb

Provider Alert! Updates to Vaccine Administration Procedure Code M0201

Date: February 26, 2024 Attention: All Providers Effective: January 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective January 1, 2024, vaccine administration add-on procedure code M0201 may be billed in the home setting with the following procedure codes: 906309063690654906559065690657906589066090661906629067090671906729067390674906779068290685906869068790688906949069790723907329073990740907439074490746907479075690759   M0201 will be payable as an add-on code if billed with any of these vaccines, along with the existing COVID-19 vaccine administration procedure code, if administered inside a client’s home. TCHP will reprocess affected claims submitted with the...

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Provider Alert!
03Jan

Provider Alert! Pegfilgrastim-pbbk (Fylnetra), Procedure Code Q5130, a Benefit of Texas Medicaid

Date: January 3, 2024 Attention: Providers Effective date: November 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after November 1, 2023, colony stimulating factors pegfilgrastim-pbbk (Fylnetra), procedure code Q5130, is a benefit of Texas Medicaid. How this impacts providers: For a list of payable diagnosis codes, providers may refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.28, “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim).”...

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Provider Alert!
27Sep

Provider Alert! Clinical Criteria for Hemgenix® (procedure code J1411) effective November 1, 2023

Date: September 26, 2023 Attention: Physicians Effective date for prior authorization criteria: November 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective November 1 2023, the Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Hemgenix® (procedure code J1411) for fee-for-service Medicaid. Hemgenix (etranacogene dezaparvovec-drlb) is an adeno-associated virus vector-based gene therapy indicated to treat adult patients with Hemophilia B (congenital Factor IX deficiency). Prior Authorization Requirements: Coverage will be provided for...

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Provider Alert!
10Apr

Provider Alert! Clinical Criteria for Xenpozyme Procedure Code J0218 effective May 1, 2023

Date: April 6, 2023 Attention: All Providers Effective Date: May 1, 2023 Call to action: Effective May 1, 2023, the Health and Human Services Commission (HHSC) will begin the incorporation of prior authorization criteria for Xenpozyme (procedure code J0218) to the Enzyme Replacement Therapy policy. Xenpozyme is the first therapy indicated specifically for the treatment of non-central nervous system manifestations of acid sphingomyelinase deficiency (ASMD) in adult and pediatric patients, and is currently the only approved treatment for this disease. Authorization Requirements 1. Member has...

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Provider Alert!
08Dec

Provider Alert! Update: New Collaborative Care Model Medicaid Benefit; Attestation Form Now Available

Date: December 5, 2022 Attention: All Providers Effective Date for attestation form: January 1, 2023 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 remind providers that the Health and Human Services Commission (HHSC) has drafted a new Medicaid...

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Provider Alert!
22Nov

Provider Alert! Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Code 90461

Date: November 22, 2022 Attention: All Providers                 Subject: Effective date: September 1, 2022 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 make providers aware that the physician administered drug vaccines and toxoids administration procedure code 90461...

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Provider Alert!
14Oct

Provider Alert! CPT Codes for Vision Testing Reminder

Date: October 12, 2022 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: The purpose of this communication is to remind providers about Texas Children’s Health Plan’s (TCHP) Current Procedural Terminology (CPT) codes for vision testing and medically necessary eye examinations. Vision...

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Provider Alert!
06Jul

Provider Alert! Antivenin Procedure Code J0841 (ANAVIP®) to Become a Medicaid Benefit

Date: July 5, 2022 Attention: All Providers Effective Date: June 1, 2022 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 Health and Human Services Commission (HHSC) has identified an alternative antivenom, Antivenin (ANAVIP) that is...

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