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.
Ophthalmic Ultrasound Services The following benefit changes apply to the procedure codes as indicated: Procedure 76510 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
extended care facility (ECF) 76511 Total component: Will no longer be reimbursed to CNM, radiation treatment center, hospital, nephrology providers in the office hospital hospital, or outpatient hospital
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
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 76516 Total component: Will no longer be reimbursed to CNM, radiation treatment center, hospital, nephrology providers in the office hospital hospital, or outpatient hospital
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 76529 Total component: Will no longer be reimbursed in the CNM, radiation treatment center, hospital, nephrology
providers in the office hospital hospital, or outpatient hospital 76999 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
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 76999 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 1900 1901 1984 2240 2241 2340 2388 23981 24950 24951 25050 25051 25052 25053 36050 36051 36052 36053 36054 36055 36059 36060 36061 36062 36063 36064 36065 36069 36100 36101 36102 36103 36104 36105 36106 36107 36110 36111 36112 36113 36114 36119 3612 36130 36131 36132 36133 36181 3619 36201 36202 36203 36204 36205 36206 36207 36210 36211 36212 36213 36214 36215 36216 36217 36218 36220 36221 36222 36223 36224 36225 36226 36227 36229 36230 36231 36232 36233 36234 36235
Diagnosis 36236 36237 36240 36241 36242 36243 36250 36251 36252 36253 36254 36255 36256 36257 36260 36261 36262 36263 36264 36265 36266 36270 36271 36272 36273 36274 36275 36276 36277 36281 36282 36283 36284 36285 36289 36340 36341 36342 36343 36361 36362 36363 36370 36371 36372 36441 36481 36482 36489 36641 37921 37926 37992 For Unlisted A-Scan Ophthalmic Ultrasound Procedures 36600 36601 36602 36603 36604 36609 36610 36611 36612 36613 36614 36615 36616 36617 36618 36619 36620 36621 36622 36623 36630 36631 36632 36633 36634 36642 36643 36644 36645 36646 36650 36651 36652 36653 3668 3669 37100 37101 37102 37103 37104 37105 37110 37111 37112 37113 37114 37115 37116 37120 37121 37122 37123 37124 37130 37131 37132 37133 37140 37141 37142 37143 37144 37145 37146 37148 37149 37150 37151 37152 37153 37154 37155 37156 37157 37158 37160 37161 37162 37170 37171 37172 37173 37181 37182 37189 3719 37931 37932 37933 37934 37939 74330 74331 74332 74333 74334 74335 74336 74337 74339 For Unlisted Ophthalmic Ultrasound Foreign Body Localization Procedures 3766 8704 8715 8716 9300 9301 9302 9308 9309 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 1-800-925-9126.