Tag - procedure code

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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10May

Provider Alert! Updated Age Range for COVID-19 Vaccine Administration Procedure Code M0201

Date: May 4, 2022 Attention: All Providers Effective date: Dates of service on or after October 29, 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for...

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27Apr

Provider Alert! COVID-19 Procedure Code S8301 Reimbursement Documentation Reminder

Date: April 25, 2022 Attention: All Providers 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied...

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Provider Alert!
16Feb

Provider Alert! Gene Expression Profiling Procedure Code 81520 to Become a Benefit Effective April 1, 2022

Date: February 9, 2022 Attention: Providers Subject: Effective Date: April 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: On September 11, 2020, Texas HHSC received a medical benefit request to add Prosigna®, a type of gene expression profiling, as a benefit of Texas Medicaid. Prosigna®...

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Provider Alert!
09Nov

Provider Alert! Update to the Durable Medical Equipment and Supplies Handbook

Date: November 4, 2021 Attention: Durable Medical Equipment, Primary Care, and Gastroenterologist Providers Effective Date: November 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: On November 1, 2021, Texas Medicaid Health Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment...

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