March Updates for THSteps Diagnostic Dental Services and Ophthalmic Ultrasound Services
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1 March Updates for THSteps Diagnostic Dental Services and Ophthalmic Ultrasound Services Information posted February 19, 2010 Effective for dates of service on or after March 1, 2010, to align with the Centers for Medicare & Medicaid Services (CMS) requirements for easy access to all Texas Medicaid fees, provider type, place-of-service (POS), and type-of-service (TOS) changes will be applied to some procedure codes, including Texas Health Steps (THSteps) diagnostic dental services and ophthalmic ultrasound services. THSteps Diagnostic Dental Services The following procedure codes will no longer be reimbursed to federally qualified health centers (FQHCs) in the inpatient hospital setting: Procedure D0120 D0140 D0150 D0160 D0170 D0180 D0210 D0220 D0230 D0250 D0260 D0270 D0272 D0274 D0277 D0290 D0310 D0320 D0321 D0322 D0330 D0340 D0350 D0415 D0425 D0460 D0470 D0999 Note: These changes do not affect the FQHC encounter payment.
2 Ophthalmic Ultrasound Services The following benefit changes apply to the procedure codes as indicated: Procedure Total component for fee-for-service claims: Will no longer be reimbursed to certified nurse midwife (CNM), radiation treatment center, and hospital-based rural health center (RHC) providers in the office May be reimbursed to optometric groups in the office physiological laboratory, hospital-based RHC, and optometric group providers in the outpatient hospital Total component for PCCM claims: Will no longer be reimbursed to CNM, radiation providers in the office hospital longer be reimbursed to nurse practitioner (NP), clinical nurse specialist (CNS), physician assistant (PA), CNM, and radiological and physiological laboratory providers in the office Will no longer be reimbursed to hospital, providers in the outpatient hospital Will no longer be reimbursed in the skilled nursing facility (SNF), intermediary care facility (ICF), independent laboratory, or
3 extended care facility (ECF) Total component: Will no longer be reimbursed to CNM, radiation treatment center, hospital, nephrology providers in the office hospital hospital, or outpatient hospital
4 76512 Total component: Will no longer be reimbursed to CNM, radiation treatment center hospital, nephrology (hemodialysis, renal dialysis), renal dialysis facility, and hospital-based RHC providers in the office hospital hospital, or outpatient hospital
5 76513 Total component: Will no longer be reimbursed in the CNM, radiation treatment center, hospital, nephrology providers in the office hospital hospital, or outpatient hospital Total component: Will no longer be reimbursed to CNM, radiation treatment center, hospital, nephrology providers in the office hospital hospital, or outpatient hospital
6 76519 Total component: Will no longer be reimbursed in the CNM, radiation treatment center, hospital, nephrology providers in the office hospital hospital, or outpatient hospital Total component: Will no longer be reimbursed in the CNM, radiation treatment center, hospital, nephrology
7 providers in the office hospital hospital, or outpatient hospital Total component: Will no longer be reimbursed to podiatrist, CNM, hospital, nephrology (hemodialysis, renal dialysis), renal dialysis facility, and hospital-based RHC providers in the office May be reimbursed to optometrist providers in the office hospital Prior authorization is required. CNM, podiatrist, and radiological and physiological laboratory providers in the office, inpatient hospital, or outpatient hospital May be reimbursed to optometrists in the office, inpatient hospital, or outpatient hospital reimbursed to podiatrist, CNM, radiation
8 treatment center, and podiatry group providers in the office May be reimbursed to optometrist providers in the office Prior authorization is required. Unlisted procedure code requires prior authorization. The provider must submit the following documentation with the request: A clear, concise description of the ophthalmic ultrasound being performed. A procedure code that is comparable to the requested ophthalmic ultrasound or the provider s intended fee for performing the ophthalmic ultrasound. One of the following diagnosis codes: Diagnosis For Unlisted Ultrasound Ophthalmic Procedures
9 Diagnosis For Unlisted A-Scan Ophthalmic Ultrasound Procedures For Unlisted Ophthalmic Ultrasound Foreign Body Localization Procedures Note: Services and procedures that are investigational or experimental are not a benefit of Texas Medicaid. For more information, call the TMHP Contact Center at
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