Banner Messages for the 12/03/07 ER&S and 12/07/07 R&S Reports

Banner Messages for the 12/03/07 ER&S and 12/07/07 R&S Reports This file contains abbreviated messages meant to provide timely notifications that affect all provider groups (physicians, dentists, and so forth). Additional current and historic information affecting the Medicaid, Medicaid Managed Care, and Children with Special Health Care Needs (CSHCN) Services Program provider community may be found in the earlier postings of these files in the TMHP banner library at www.tmhp.com as well as in the bi-monthly editions of the Texas Medicaid Bulletin and the quarterly CSHCN Services Program Provider Bulletin, which update the Texas Medicaid Provider Procedures Manual and CSHCN Services Program Provider Manual, respectively. Copyright Acknowledgements Use of the American Medical Association s (AMA) copyrighted Current Procedural Terminology (CPT) is allowed in this publication with the following disclosure: Current Procedural Terminology (CPT) is copyright 2007 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regulation System/Department of Defense Regulation System (FARS/DFARS) restrictions apply to government use. The American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT) codes: CDT 2007/2008 [including procedure codes, definitions (descriptions), and other data] is copyrighted by the American Dental Association. (c) 2006 American Dental Association. All Rights Reserved. Applicable Federal Acquisition Regulation System/Department of Defense Acquisition Regulation System (FARS/DFARS) restrictions apply. Microsoft Corporation requires the following notice in publications containing trademarked product names: Microsoft and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. Total Messages (35) 1 (12/07/07 through 12/28/07) *****Attention All Medicaid Effective April 1, 2008, the Health and Human Services Commission (HHSC) will implement a statewide managed care program for Texas Medicaid clients who are in foster care. The State of Texas Access Reform (STAR) Health Program will ensure that children taken into state conservatorship are able to receive the examinations, assessments, and care coordination they need within the first few days of their entry into conservatorship. Details of these changes are available on the TMHP website at www.tmhp.com and will also be published in the March/April 2008 Texas Medicaid Bulletin, No. 214. 2 (12/07/07 through 12/28/07) *****Attention All Medicaid On December 14, 2007, TMHP will implement enhancements to the Online Prior Authorization Submission functionality of the TMHP website at www.tmhp.com for the Texas Medicaid Program and Primary Care Case Management (PCCM) Program. These enhancements will allow providers to submit PCCM inpatient and 1 of 11

outpatient requests for diagnosis-related group (DRG) and clinical updates and updates to surgical procedure codes. Other enhancements include the addition of new and required fields for several authorization types. For more information, refer to the TMHP website at www.tmhp.com and the March/April 2008 Texas Medicaid Bulletin, No. 214. On December 13, 2007, an updated Online Prior Authorization Submission Provider Training Manual will be published on the TMHP website at www.tmhp.com with the specific details of the enhancements. 3 (12/07/07 through 12/28/07) *****Attention All Medicaid Effective March 1, 2008, the Primary Care Case Management (PCCM) primary care provider name will no longer be listed on the Medicaid Identification Form (Form H3087). The change will reduce provider and client confusion that can result following a change to the primary care provider. Details of these changes are available on the TMHP website at www.tmhp.com and will be published in the March/April 2008 Texas Medicaid Bulletin, No. 212. For more information call the PCCM Provider Helpline at 1-888-834-7226 or the TMHP Contact Center at 1-800-925-9126. 4 (12/07/07 through 12/28/07) *****Attention All Medicaid TMHP has identified an issue concerning the billing of procedure code 2-58300 in conjunction with procedure code 1-J7302. Effective for dates of service on or after September 1, 2007, procedure code 2-58300 may be considered for reimbursement separately from procedure code 1-J7302. Claims submitted between September 1, 2007, and November 15, 2007, with dates of service on or after September 1, 2007, and procedure codes 2-58300 and 1-J7302 may have been denied in error. These claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. 5 (12/07/07 through 12/14/07) *****Attention All Medicaid Reminder: Complete blood count (CBC) panels and their components are benefits of the Texas Medicaid Program. The individual components of a CBC panel are categorized as hemogram (procedure codes 5-85013, 5-85014, 5-85018, 5-85041, and 5-85048), differential analysis (procedure codes 5-85004, 5-85007, 5-85008, and 5-85009), platelet (procedure code 5-85049), and reticulocyte (procedure codes 5-85044, 5-85045, and 5-85046). If only one component is performed, the most appropriate procedure code must be billed for the procedure performed. If more than one component is performed, a CBC procedure code must be billed (procedure code 5-85025, 5-95027, or 5-85032). If more than one individual component is billed with the same date of service by the same provider, the first procedure code is considered for reimbursement and all other procedure codes are denied. Exception: Reticulocyte procedure codes may be considered for reimbursement in addition to any of the other procedure codes mentioned above. 6 (12/07/07 through 12/28/07) *****Attention All Medicaid Effective February 1, 2007, newly enrolled Primary Care Case Management (PCCM) clients can select a primary care provider before one is assigned to them. Clients who lose Medicaid eligibility and regain it within six months are automatically assigned their last primary care provider on record. 2 of 11

PCCM clients who do not have a primary care provider listed on their Medicaid ID will have either "PCCNEWB01" (newborns) or "PCCPCCM01" (all clients except for newborns) in place of a primary care provider's name. Any primary care provider may provide services to PCCM clients who have PCCNEWB01 or PCCPCCM01 on their Medicaid ID. Providers can verify client eligibility in any of four ways: using their Medicaid ID, electronically on the TMHP website at www.tmhp.com, through the Automated Inquiry System (AIS) at 1-800-925-9126, or on the current month's panel report. For more information, visit the PCCM webpage of the TMHP website at www.tmhp.com, or call the PCCM Provider Helpline at 1-888-834-7226. 7 (11/30/07 through 12/21/07) *****Attention All Medicaid TMHP has identified an issue impacting claims for personal care services. Effective September 1, 2007, home health agencies and consumer-directed agencies that bill for personal care services (procedure code 1-T1019) may have received a message on their Remittance and Status (R&S) report indicating that some of the services exceed allowed benefit limitations (explanation of benefit [EOB] 00103). Agencies that bill for personal care services on a UB-04 CMS-1450 claim form must itemize charges per client, per day to avoid a reduction in units of service. As a reminder, personal care services cannot exceed 24 hours or 96 units per client, per day, per provider. TMHP is in the process of identifying which agencies had claims processed on or before November 16, 2007, that were impacted by this EOB. Only the services on the claim that received EOB 00103 will be reprocessed, and payments will be adjusted accordingly. TMHP will conduct a one-time reprocessing effort for the identified claims, and no action on the part of the provider is necessary. Claims that were processed after November 16, 2007, and received EOB 00103 must be resubmitted with the services itemized per client, per day of service. 8 (11/30/07 through 12/21/07) *****Attention All Medicaid Effective November 13, 2007, for dates of service on or after September 1, 2007, federally qualified health centers (FQHCs) may be reimbursed for up to three encounter rates per calendar year, per client for family planning visits that are provided under Title XIX if only family planning services are provided during the visit. Effective November 13, 2007, for dates of service on or after October 30, 2007, FQHCs may be reimbursed for up to three encounter rates per calendar year, per client for family planning visits provided through the Women's Health Program (WHP). Claims submitted before November 13, 2007, that were incorrectly denied will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. To obtain the encounter rate, family planning services provided during either a WHP visit or an encounter in which only family planning services were provided must be billed using one of the following procedure codes: 1-99204 with modifier FP, 1-99214 with modifier FP, or 1-J7300. These procedure codes must be submitted in addition to the most appropriate informational procedure codes for services that were rendered. To be reimbursed an encounter rate for any family planning service other than an intrauterine device or an annual exam for a new patient, FQHCs should bill procedure code 1-99214 with modifier FP for visits in which only family planning services are provided. These include family planning services that are not annual exams and visits during which only a contraceptive injection is provided. 3 of 11

9 (11/23/07 through 12/14/07) *****Attention All Medicaid Effective November 8, 2007, for dates of service on or after October 30, 2007, procedure codes 4/I/T-74000, 4/I/T-74010, 5-80061, 5-86580, 5-86689, and 5-86592 are a benefit of the Texas Medicaid Program through the Women's Health Program (WHP). Claims for these procedure codes must include a family planning diagnosis code to be considered for reimbursement through WHP. Claims submitted for WHP services with dates of service from October 30, 2007, through November 8, 2007, and any of the procedure codes listed above will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. 10 (11/16/07 through 12/07/07) *****Attention All Medicaid Effective January 1, 2008, prior authorization for in-home total parenteral nutrition (TPN)/hyperalimentation must be submitted to TMHP using the Medicaid Certificate of Medical Necessity for In-Home Total Parenteral Nutrition (TPN) form. The form is available in the Provider Forms section of the TMHP website at www.tmhp.com, and it will be published in the March/April 2008 Texas Medicaid Bulletin, No. 214. 11 (11/16/07 through 12/07/07) *****Attention All Medicaid This is an update to an article that was published in the September/October 2007 Texas Medicaid Bulletin, No. 208, entitled, "Alglucosidase alfa (Myozyme)." The article stated that alglucosidase alfa (Myozyme) is a benefit of the Texas Medicaid Program for clients younger than 21 years of age and that providers may fax or mail prior authorization requests, including all required documentation, to the Texas Health Steps- Comprehensive Care Program (THSteps-CCP) Prior Authorization Department. The age limitations and prior authorization department have changed. The following is the updated information: Effective for dates of service on or after January 1, 2007, alglucosidase alfa (Myozyme) is a benefit of the Texas Medicaid Program for clients of any age who are diagnosed with glycogenosis, or Pompe disease. Providers may fax or mail prior authorization requests for procedure code 1-S0147 to the TMHP Special Medical Prior Authorization Department at: Texas Medicaid & Healthcare Partnership Attn: Special Medical Prior Authorization Department 12357-B Riata Trace Parkway, Suite 150 Austin, TX 78727 Fax: 1-512-514-4213 Prior authorization is a condition for reimbursement; it is not a guarantee of payment. 12 (11/16/07 through 12/07/07) *****Attention All Medicaid TMHP has identified an issue impacting anesthesia claims. Effective for dates of service on or after December 1, 2006, procedure code 7-01968 or 7-01969 may be considered for reimbursement when submitted with procedure code 7-01967. For a planned vaginal delivery, the anesthesia administered during labor must be billed with procedure code 7-01967, and must include the time in minutes that represents the time between the start and stop times for the procedure. The additional anesthesia services administered during the operative session for a cesarean delivery must be submitted using procedure code 7-01968 or 7-01969, and must include 4 of 11

the time spent administering the epidural and the actual face-to-face time spent with the client. The insertion and the injection of the epidural are not considered separately for reimbursement. All time must be documented in block 24D of the claim form or the appropriate field of the chosen electronic format. Claims submitted on or after December 1, 2006, through January 1, 2008, with procedure codes 7-01967 and 7-01968 or procedure codes 7-01967 and 7-01969 will be reprocessed and payments adjusted accordingly. No action of the part of the provider is necessary. 13 (11/16/07 through 12/07/07) *****Attention All Medicaid Effective November 1, 2007, for dates of service on or after July 1, 2007, providers may submit claims for immune globulin services with procedure code 1-J1567, 1-Q4087, 1-Q4088, 1-Q4089, 1-Q4091, or 1-Q4092 and an appropriate diagnosis code. Procedure code 1-J1567 will be denied if it is submitted for reimbursement with the same date of service as procedure code 1-Q4087, 1-Q4088, 1-Q4089, 1-Q4091, or 1-Q4092. Details of these changes, including diagnosis restrictions and other limitations, are available on the TMHP website at www.tmhp.com and will also be available in the March/April 2008 Texas Medicaid Bulletin, No. 214. 14 (11/16/07 through 12/07/07) *****Attention All Medicaid This is a correction to a website article posted on October 8, 2007, entitled "Renal Dialysis Benefits To Change." The article stated that effective December 1, 2007, the following equipment and supply procedure codes are benefits of the Texas Medicaid Program: 9-A4218, 9-A4653, 9-A4671, 9-A4672, 9-A4673, 9-A4674, J/L-E0425, L-E0430, L-E0435, L-E0440, L-E1500, L-E1610, L-E1615, J/L-E1625, L-E1634, 1-J2001, 1-J7030, 1-J7040, 1-J7042, 1-J7050, 1-J7060, 1-J7070, and 1-J7130. These codes will not be made a benefit of the Texas Medicaid Program. The complete, corrected article is available on the TMHP website at www.tmhp.com. Details of these changes will also be published in the January/February 2008 Texas Medicaid Bulletin, No. 212. 15 (11/16/07 through 12/07/07) *****Attention All Medicaid Effective for dates of service on or after January 1, 2008, benefits and limitations for genetic testing for colorectal cancer will change for the Texas Medicaid Program. Details of these changes are available on the TMHP website at www.tmhp.com and will be available in the March/April 2008 Texas Medicaid Bulletin, No. 214. 16 (11/16/07 through 12/07/07) *****Attention All Medicaid Effective for dates of service on or after January 1, 2008, the following drug procedure codes are no longer a benefit of the Texas Medicaid Program:, J0350, J0900, J1056, J1180, J1320, J1452, J1810, J2513, J2910, J2995, and J9270. 5 of 11

17 (11/16/07 through 12/07/07) *****Attention All Medicaid TMHP has identified an issue impacting claims submitted with dates of service on or after December 1, 2006, and procedure code L-K0842. Procedure code L-K0842 was incorrectly reimbursed at $281.50. Effective December 1, 2006, procedure code L-K0842 should have been reimbursed at $431.86. Effective October 26, 2007, claims submitted with dates of service on or after December 1, 2006, and procedure code L-K0842 will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. 18 (11/30/07 through 12/21/07) *****Attention All Medicaid and Ambulance For prior authorizations submitted on or after October 31, 2007, the maximum authorization period for nonemergency ambulance transports has changed to 180 days for the Texas Medicaid Program. Providers that request an annual authorization on or after October 31, 2007, may be issued a long-term, 180-day authorization if all of the requirements are met. Authorizations for 180-day periods will only be issued if the client meets medical necessity and the requesting provider submits the Physician's Medical Necessity Certification for Non-emergency Ambulance Transports form. The Ambulance Fax Cover Sheet may only be submitted for transports of 60 days or fewer. The updated Ambulance Fax Cover Sheet is available on the TMHP website at www.tmhp.com and will also be available in the March/April 2008 Texas Medicaid Bulletin, No. 214. Annual authorizations received from TMHP before October 31, 2007, remain valid and will not be changed to a 180-day authorization. 19 (12/07/07 through 12/28/07) *****Attention All Medicaid DME Effective for dates of service on or after December 7, 2007, hypertonic saline 7 percent (Hyper-Sal) is a benefit of the Texas Medicaid Program for clients with a diagnosis of cystic fibrosis. Hypertonic saline 7 percent requires prior authorization and may be billed using procedure code 9-T1999. To request prior authorization, providers must submit either the manufacturer's suggested retail price (MSRP) or the average wholesale price (AWP). Providers may be reimbursed 82 percent of the MSRP or 85 percent of the AWP per ampoule. 20 (11/16/07 through 12/07/07) *****Attention All Medicaid Fee-for-Service and PCCM The Clinical Guidelines for Advanced Diagnostic Imaging guide can be accessed from the Provider Manuals and Guides section of the homepage of the TMHP website at www.tmhp.com and also from the File Library. The Guidelines are based upon the American College of Radiology (ACR) Appropriateness Criteria ; the National Comprehensive Cancer Network (NCCN) Clinical Guidelines in Oncology ; evidence-based clinical data, to the extent that they are available; consensus statements from specialty societies, such as the American College of Cardiology; published literature in peer-reviewed journals; input from practicing clinicians in academic institutions and community-based physicians; and similar sources. Clinical guidelines are available to evaluate studies including, but not limited to, computed tomography (CT), computed tomography angiography (CTA), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and nuclear medicine imaging. 6 of 11

The following imaging guidelines are available: abdominal, cardiac, chest, head, musculoskeletal, neck, oncology, pelvis, peripheral nerve, peripheral vascular disease (PVD), and spine. Specific pediatric guidelines are highlighted. In all other cases, imaging guidelines for the pediatric population should follow those for adults. 21 (11/16/07 through 12/07/07) *****Attention All Medicaid and THSteps Medical Effective for dates of service on or after October 31, 2007, Texas Health Steps (THSteps) medical providers may choose the laboratory to which they send THSteps laboratory specimens for blood test screening for hyperlipidemia or Type 2 diabetes (procedure codes 5-80061, 5-82465, 5-82947, 5-82952, 5-83718, and 5-84478). Blood specimens for the above tests that are collected as part of a THSteps medical check up may be sent to the provider's laboratory of choice. Laboratories that bill for these procedure codes on the same date of service as a medical check up visit can be reimbursed separately. Providers that obtain and process these specimens in-house will not be reimbursed separately. 22 (12/07/07 through 12/28/07) *****Attention All TMHP will require the use of National Drug Code (NDC) on claim forms effective January 1, 2008. This message is in response to providers seeking clarification from TMHP about the proper way to submit NDC data on claim forms. The NDC is only required on outpatient hospital claims and physician claims. The NDC does not require a claim detail in addition to outpatient line items with revenue and Healthcare Common Procedure Coding System (HCPCS) codes. Instead, the NDC is added to the existing claim detail. The NDC is required only when a claim includes a HCPCS code that is listed on the Palmetto Government Business Association (GBA) crosswalk file for the date that the drug was administered. Providers can find the crosswalk files at www.palmettogba.com. Providers should enter the NDC quantity that is consistent with the procedure quantity submitted when converted to a valid American National Standards Institute (ANSI) 4010 X12 Health Insurance Portability and Accountability Act (HIPAA) unit of measure (UOM). Examples can be found on the TMHP website at www.tmhp.com. 23 (11/30/07 through 12/21/07) *****Attention All This is a correction to a banner message that first appeared on the November 9, 2007, Remittance and Status (R&S) report about full compliance with National Provider Identifier (NPI). The banner message incorrectly listed 210 as the bulletin number for the January/February 2008 Texas Medicaid Bulletin. The correct bulletin number for the January/February 2008 Texas Medicaid Bulletin is 212. 7 of 11

24 (11/16/07 through 12/07/07) *****Attention All System maintenance for the TMHP website at www.tmhp.com is scheduled for Friday, November 30, 2007, 8 p.m. through Saturday, December 1, 2007, 8 p.m. During system maintenance, some of the applications on the TMHP website will be unavailable. Batch claims and batch claims status inquiries (CSIs) will be available through the TMHP Electronic Data Interchange (EDI) Gateway during the maintenance period for TDHconnect and third-party software users. The Automated Inquiry System (AIS) will also be available for eligibility verification during this period. The following functions will not be available on the TMHP website during the maintenance period: TexMedConnect, including eligibility verification, CSI, and claims/appeals submission. Prior authorization submission. Panel reports. Remittance and Status (R&S) reports. Long Term Care (LTC) Online Portal. Security functions. 25 (12/14/07 through 01/04/08) *****Attention All SHARS The Centers for Medicare & Medicaid Services (CMS) requires each provider of school-based services programs (known in Texas as School Health and Related Services [SHARS]) to submit an annual cost report. School districts submitting claims for reimbursement for SHARS provided for dates of service during fiscal year 2007 (i.e., September 1, 2006, through August 31, 2007) must submit a 2007 SHARS Cost Report on or before March 1, 2008. Failure to file an acceptable cost report by the cost report due date in accordance with applicable instructions and training materials may result in the placement of a hold on provider payments until an acceptable cost report is received by the HHSC Rate Analysis Department. Details of this requirement and information regarding upcoming training can be found on the HHSC Rate Analysis SHARS website at www.hhsc.state.tx.us/medicaid/programs/rad/acutecare/shars/shars.html. For more information, contact Nancy Kimble, HHSC Rate Analysis for Acute Care Services at 1-512-491-1363 or nancy.kimble@hhsc.state.tx.us. 26 (12/7/2007 through 12/14/2007) *****Attention All STAR+PLUS Reminder: Freestanding psychiatric facility claims and inpatient claims with a behavioral health primary diagnosis that are submitted for clients who are enrolled in a STAR+PLUS plan will be processed by the STAR+PLUS health maintenance organizations (HMOs). TMHP will deny these claims. Providers must file these types of claims with the appropriate HMO. This process was implemented for the Harris and Harris Expansion Service Areas for dates of service on or after June 1, 2007, and for the Bexar, Nueces, and Travis service areas for dates of service on or after September 1, 2007. Claims for mental health case management and rehabilitative services that are delivered by mental health mental retardation (MHMR) facilities are not included, since they remain carved out of the managed care model. 8 of 11

27 (12/07/07 through 12/28/07) *****Attention All Medicaid and CSHCN Services Program On October 30, 2007, type of service (TOS) 4, I, T, 2, and 8 procedure codes were assigned reimbursement rates at a public rate hearing. The benefits and limitations for these codes were listed in the January 2007 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 200. The rates will be effective January 23, 2008, for dates of service on or after January 1, 2007. A complete list of the procedure codes and reimbursement rates is available on the TMHP website at www.tmhp.com and will be published in the March/April 2008 Texas Medicaid Bulletin, No. 214, and in the February 2008 CSHCN Services Program Provider Bulletin, No. 65. Claims submitted with dates of services on or after January 1, 2007, and any of the procedure codes listed on the website will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. 28 (11/30/07 through 12/21/07) *****Attention All Medicaid and CSHCN Services Program Effective for dates of service on or after January 14, 2008, procedure code 2/8-28305 will be payable to podiatrists for the Texas Medicaid Program and the Children with Special Health Care Needs (CSHCN) Services Program. This procedure code will no longer be payable to certified nurse-midwives (CNMs). 29 (11/23/07 through 12/14/07) *****Attention All Medicaid and CSHCN Services Program Effective January 16, 2008, procedure codes 9-A9500 and 9-A9502 are limited to a quantity of three per day, any provider. 30 (11/16/07 through 12/07/07) *****Attention All Medicaid and CSHCN Services Program This is a correction to information published in the January 2007 HCPCS Special Bulletin, No. 200. The bulletin incorrectly indicated that procedure code 1-S0180 is a benefit of the Children with Special Health Care Needs (CSHCN) Services Program. Effective for dates of service on or after January 1, 2007, procedure code 1-S0180 is not a benefit of the CSHCN Services Program. In addition, an article entitled, "2007 HCPCS Rates" was published on the TMHP website at www.tmhp.com on October 1, 2007, which included procedure code 1-S0180. The article should have indicated that procedure code 1-S0180 is not a benefit of the CSHCN Services Program. 9 of 11

31 (11/16/07 through 12/07/07) *****Attention All Medicaid and CSHCN Services Program Effective for dates of service on or after January 1, 2008, procedure code 1-J0740 is no longer restricted to diagnosis code 36320 for the Texas Medicaid Program or the Children with Special Health Care Needs (CSHCN) Services Program. All claims must include a valid 3- to 5-digit diagnosis code to be processed correctly. The diagnosis must be coded to the highest level of specificity. 32 (11/16/2007 through 12/07/2007) *****Attention Medicaid and CSHCN Services Program On January 1, 2008, TMHP will implement the annual Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after January 1, 2008. Deleted procedure codes will no longer be benefits of the Texas Medicaid Program or the Children with Special Health Care Needs (CSHCN) Services Program for dates of service after December 31, 2007. Details of the affected changes to provider procedure codes will be published in the 2008 HCPCS Special Bulletin, No. 213, which will be available on December 31, 2007, on the TMHP website at www.tmhp.com. Providers will be mailed a printed copy of the bulletin in February 2008. 33 (11/16/07 through 12/07/07) *****Attention All Medicaid and CSHCN Services Program On September 24, 2007, reimbursement rates for the procedure codes listed below were assigned at a public rate hearing. Effective November 1, 2007, for dates of service on or after July 1, 2007, the rates for the procedure codes are as follows: Procedure code 1-Q4083 has a rate of $102.11. Procedure code 1-Q4084 has a rate of $178.66. Procedure code 1-Q4085 has a rate of $111.48. Procedure code 1-Q4086 has a rate of $178.24. Procedure code 1-Q4087 has a rate of $33.48. Procedure code 1-Q4088 has a rate of $31.20. Procedure code 1-Q4089 has a rate of $5.33. Procedure code 1-Q4090 has a rate of $64.74. Procedure code 1-Q4091 has a rate of $32.61. Procedure code 1-Q4092 has a rate of $31.86. Procedure code 1-Q4093 has a rate of $0.13. Procedure code 1-Q4094 has a rate of $0.53. Procedure code 1-Q4095 has a rate of $220.81. 10 of 11

Procedure code J-K0553 has a rate of $179.35. Procedure code J-K0554 has a rate of $49.54. Procedure code J-K0555 has a rate of $20.24. Claims submitted with dates of service on or after July 1, 2007, and any of the procedure codes listed above will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. 34 (12/07/07 through 12/28/07) *****Attention All CSHCN Services Program Effective October 12, 2007, the custom durable medical equipment (DME) prior authorization period has changed for the Children with Special Health Care Needs (CSHCN) Services Program. Custom DME authorization periods will be no less than 75 days from the date of approval. If the client's eligibility is due to end before the 75 days, providers may still receive a 75-day authorization from date of approval and their claims may be considered for reimbursement. For more information, call the TMHP-CSHCN Services 35 (11/16/07 through 12/07/07) *****Attention All CSHCN Services Program Effective November 1, 2007, for dates of service on or after July 1, 2007, providers may submit claims for immune globulin services with procedure code 1-J1567, 1-Q4087, 1-Q4088, 1-Q4090, 1-Q4091, or 1-Q4092 and an appropriate diagnosis code. Procedure code 1-J1567 will be denied if it is submitted for reimbursement with the same date of service as procedure code 1-Q4087, 1-Q4088, 1-Q4090, 1-Q4091, or 1-Q4092. Details of these changes, including diagnosis restrictions and other limitations, are available on the TMHP website at www.tmhp.com and will also be available in the February 2008 CSHCN Services Program Provider Bulletin, No. 65. For more information, call the TMHP-CSHCN Services 36 (11/16/07 through 12/07/07) *****Attention All CSHCN Services Program This is a correction to a banner message that first appeared on the September 28, 2007, Remittance and Status (R&S) report about dialysis access surgery procedure codes. The banner message incorrectly listed procedure code 2-38622. The correct procedure code is 2-36822. The following are the correct procedure codes and their rates: Procedure code 2-36822 (20 years of age and younger) has a rate of $255.58. Procedure code 2-36822 (21 years of age and older) has a rate of $268.36. For more information, call the TMHP-CSHCN Services 11 of 11