Banner Messages for the 03/03/08 ER&S and 03/07/08 R&S Reports

Banner Messages for the 03/03/08 ER&S and 03/07/08 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 (46) 1 (03/07/08 through 03/28/08) *****Attention All Medicaid Providers***** This is an update to a banner message about private duty nursing (PDN) services (procedure code C-T1000) that first appeared on the February 22, 2008, Remittance and Status (R&S) report. Effective for dates of service on or after March 1, 2008, the reimbursement rate for procedure code C-T1000 when billed by a home health agency with modifier TD has changed from $8.25 to $11.28 per 15 minutes. Procedure code C-T1000 with modifier TE will continue to be reimbursed at $8.25 per 15 minutes. Procedure code C-T1000 requires prior authorization. Prior authorization requests must include the required hours for only procedure code C-T1000 and must be submitted by fax to the Texas Health Steps- Comprehensive Care Program (THSteps-CCP) Prior Authorization Department at 512-514-4215 or in writing to the following address: Texas Medicaid & Healthcare Partnership, Attn: Comprehensive Care Program, PO Box 200735, Austin, TX 78720-0555. Modifiers and rates are not required when requesting prior authorization for PDN services. Claims should be submitted to TMHP with procedure code C-T1000 and the appropriate TD or TE modifier. Claims submitted with procedure code C-T1000 but without modifier TD or TE will be denied. 1 of 14

Details of these changes will be published in the May/June 2008 Texas Medicaid Bulletin, No. 215. For more information, call the TMHP Contact Center at 1-800-925-9126. 2 (03/07/08 through 03/28/08) *****Attention All Medicaid Providers***** As indicated in banner messages on the December 15, 2006, and January 28, 2007, Remittance and Status (R&S) reports, effective for dates of service on or after February 1, 2007, inpatient hospital claims for State of Texas Access Reform (STAR)+PLUS clients will be processed by TMHP and reimbursed as fee-for-service claims. This information was also included in the Health and Human Services Commission (HHSC) STAR+PLUS Hospital Provider Training on the HHSC website at www.hhsc.state.tx.us/starplus/provider_info.html. The spell-of-illness limitation applies to clients in the STAR+PLUS Program. A spell-of-illness is defined as 30 days of inpatient hospital care, which may accrue intermittently or consecutively. After 30 days of inpatient care is provided, reimbursement for additional inpatient care is not considered until the client has been out of an acute care facility for 60 consecutive days. This is a correction to the 2008 Texas Medicaid Provider Procedures Manual, Section 1.4, "Texas Medicaid Program Limitations and Exclusions," on page 1-20, and Section 7.3.2, "STAR+PLUS Program Benefits," on page 7-19. Freestanding psychiatric facility claims and inpatient claims with a behavioral health primary diagnosis submitted for clients who are enrolled in a STAR+PLUS plan will be processed by the STAR+PLUS HMOs. 3 (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** Reminder: Effective for dates of service on or after April 1, 2008, the following services will be benefits of the Texas Medicaid Program: Brachytherapy services. Chemotherapy services. Electromyography (EMG) and nerve conduction studies (NCS). Implantable infusion pumps. Iron studies. Lung volume reduction surgery (LVRS) (including the preoperative pulmonary rehabilitation service for preparation for LVRS and post-discharge pulmonary surgery services after LVRS). Radiation therapy services. Stereotactic radiosurgery services. Therapeutic radiopharmaceuticals. Wearable cardiac defibrillator (WCD) (procedure codes 1-93745, L-K0606, or 9-K0606). Details of these changes are available on the TMHP website at www.tmhp.com and will be published in the May/June 2008 Texas Medicaid Bulletin, No. 215. 4 (03/07/08 through 03/28/08) *****Attention All Medicaid Providers***** The 2008 Texas Medicaid Fee Schedules are now available on the TMHP website at www.tmhp.com. 2 of 14

Fee schedules can be downloaded from the website as either portable document format (PDF) files or Microsoft Excel spreadsheets. Providers can request a free paper copy of a fee schedule by calling the TMHP Contact Center at 1-800-925-9126. 5 (03/07/08 through 03/28/08) *****Attention All Medicaid Providers***** Rates have been assigned for procedure codes 1-C9236, 1-J1300, and 1-J9261. Details of the rates are available on the TMHP website at www.tmhp.com and will be published in the July/August 2008 Texas Medicaid Bulletin, No. 216. 6 (02/29/08 through 03/21/08) *****Attention All Medicaid Providers***** Effective March 1, 2008, the following enhancements will be made to the online provider lookup tool: The provider update page will include collapsible boxes, frames, and borders, which will make it easier to use. On the expanded results page, a green checkmark will appear next to plans in which the provider is a primary care provider. The Health Plan drop-down menu will show STAR and STAR+PLUS separately. 7 (02/29/08 through 03/21/08) *****Attention All Medicaid Providers***** This is an update to an article posted on the TMHP website on January 9, 2008, entitled, "Medicaid Medical Nutrition Counseling Services Benefit to Change." Additional benefit information has been added to the article. The updated article is available on the TMHP website at www.tmhp.com and will also be available in the May/June 2008 Texas Medicaid Bulletin, No. 215. 8 (02/29/08 through 03/21/08) *****Attention All Medicaid Providers***** Many Integrated Care Management (ICM) clients are eligible for both Medicaid and Medicare. Medicare enrollment does not affect eligibility for ICM. For clients who are enrolled in both Medicaid and Medicare, ICM is responsible only for long-term services and supports. Primary acute-care and pharmacy services for this population are covered by and should be billed to Medicare. Enrollment in ICM will not change the way a client receives Medicare services. Additional information is available on the TMHP website at www.tmhp.com and will be published in the July/August Texas Medicaid Bulletin, No. 216. 9 (02/29/08 through 03/21/08) *****Attention All Medicaid Providers***** This is an update to a banner message that appeared on the January 18, 2008, Remittance and Status (R&S) report about vaccines/toxoids and procedure code 1-J1670. The banner message stated that effective for dates of service on or after March 1, 2008, the benefit criteria for vaccines/toxoids and procedure code 1-J1670 will change for the Texas Medicaid Program. The implementation of these benefit changes has been postponed, and the Health and Human Services Commission (HHSC) is currently reviewing the policy. Providers should monitor future banner messages and the Texas Medicaid Bulletin for information about benefit changes related to vaccines/toxoids and procedure code 1-J1670. 3 of 14

10 (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** Effective March 1, 2008, the Texas Medicaid Program will increase the reimbursement rate for the following transport portable X-ray services: Procedure code 4-R0070 will have a reimbursement rate of $148.31. Procedure code 4-R0075 with modifier UN will have a reimbursement rate of $74.16. Procedure code 4-R0075 with modifier UP will have a reimbursement rate of $49.44. Procedure code 4-R0075 with modifier UQ will have a reimbursement rate of $37.08. Procedure code 4-R0075 with modifier UR will have a reimbursement rate of $29.66. Procedure code 4-R0075 with modifier US will have a reimbursement rate of $24.72. Procedure code 4-R0075 must be submitted with modifier UN, UP, UQ, UR, or US. If procedure code 4-R0075 is submitted without the appropriate modifier, the claim will be denied. 11 (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** Effective April 1, 2008, the Health and Human Services Commission (HHSC) will launch STAR Health, a new health-care program to improve services and better coordinate care for children in foster care. HHSC has contracted with Superior HealthPlan to provide services for this program. More information about STAR Health is located on the TMHP website at www.tmhp.com and will be published in the May/June 2008 Texas Medicaid Bulletin, No. 215. 12 (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** TMHP has identified an issue with claims submitted with hematopoietic injections procedure codes 1-J0881, 1-J0882, 1-J0885, and 1-J0886. Details of this issue are located on the TMHP website at www.tmhp.com. 13 (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** This is a correction to a banner message that first appeared on the December 7, 2007, Remittance & Status (R&S) report. The banner message indicated that if more than one component is performed, a complete blood count (CBC) procedure code must be billed (procedure code 5-85025, 5-95027, or 5-85032). Procedure code 5-95027 is incorrect. The correct procedure code is 5-85027. The corrected statement is as follows: If more than one component is performed, a CBC procedure code must be billed (procedure code 5-85025, 5-85027, or 5-85032). The complete, corrected article will be available in the March/April 2008 Texas Medicaid Bulletin, No. 214. 14 (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** On January 30, 2008, reimbursement rates for the procedure codes listed below were assigned at a public rate hearing. Effective for dates of service on or after March 1, 2008, the rates for the following laser eye surgery procedure codes will change for the Texas Medicaid Program: 4 of 14

Procedure code 2-65772 will have a reimbursement rate of $260.05 (9.08 relative value units (RVUs), $28.640 conversion factor). Procedure code F-65772 will be reimbursed under ambulatory surgical center (ASC) Group 4. Procedure code 2-65775 will have a reimbursement rate of $352.56 (12.31 RVUs, $28.640 conversion factor). Procedure code F-65775 will be reimbursed under ASC Group 4. Procedure code F-65450 will be reimbursed under ASC Group 2. Procedure code F-66770 will be reimbursed under ASC Group 3. 15 (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** The augmentative communication device (ACD) systems policy information is not current in the 2008 Texas Medicaid Provider Procedures Manual, section 24.5.16, "Augmentative Communication Device (ACD) System" on page 24-32. The current policy and benefit information for ACDs covered under home health services is located in the 2007 Texas Medicaid Provider Procedures Manual, section 24.5.12, Augmentative Communication Device (ACD) System on page 24-27. The Health and Human Services Commission (HHSC) is reviewing the current policy for ACDs. Any revisions to the ACD policy and benefit information will be published in the May/June 2008 Texas Medicaid Bulletin, No. 215. 16 (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** The Health and Human Services Commission (HHSC) has identified an error impacting some claims for the Women's Health Program (WHP). Some WHP clients whose year-long certification period expired on December 31, 2007, received new identification cards showing eligibility for January 2008 in error. The affected clients eligibility will be updated to include the month of January 2008. Claims may have been denied in error with explanation of benefits (EOB) 01140 Unable to assign program/benefit plan." They may continue to be denied until TMHP s eligibility verification systems have been updated to reflect client eligibility for the month of January 2008. Claims affected by this error will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. 17 (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** On March 1, 2008, TMHP will implement enhancements to the online prior authorization submission functionality on the TMHP website. Details of the enhancements are available on the TMHP website at www.tmhp.com and will be published in the May/June 2008 Texas Medicaid Bulletin, No. 215. 18 (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** The instructions for the TMHP Standardized MRAN templates found in the 2008 Texas Medicaid Provider Procedure Manual, Sections 5.12.2 and 5.12.4 have been revised. The revised instructions include information 5 of 14

about the requirement for typed or computer-generated templates. The revised instructions are available on the TMHP website at www.tmhp.com and will be published in the May/June 2008 Texas Medicaid Bulletin, No. 215. 19 (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** The Centers for Disease Control and Prevention (CDC) has released the 2008 Recommended Childhood and Adolescent Immunization Schedule that indicates the recommended age for routine administration of currently licensed childhood vaccines. The 2008 Recommended Childhood and Adolescent Immunization Schedule is approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). Providers who offer immunization services should obtain and refer to the schedule or schedules that affect their client populations. The 2008 schedule may be downloaded from the CDC website at: www.cdc.gov/vaccines/recs/schedules/childschedule.htm#printable. For more information about the 2008 Recommended Childhood and Adolescent Immunization Schedules, call the Department of State Health Services (DSHS) Immunization Branch at 1-800-252-9152. 20 (02/15/2008 through 03/07/2008) *****Attention All Medicaid Providers***** This is a correction and an update to an article published in the November/December 2006 Texas Medicaid Bulletin, No. 199, entitled, Changes in Billing Procedures for State School Services. The article stated that effective September 1, 2006, providers can no longer bill TMHP for off-campus acute care services provided to Medicaid-eligible state school residents, except for inpatient hospital care for individuals that are eligible for Supplemental Security Income (SSI) Medicaid. The effective date indicated in the article is incorrect. The correct date is January 1, 2006. Additionally, beginning April 1, 2008, claims for off-campus acute care services provided to Medicaid-eligible state school residents (excluding inpatient hospital care for individuals that are eligible for SSI Medicaid) submitted to TMHP with dates of service on or after January 1, 2006, will be recouped and payments adjusted accordingly. The complete, corrected article is available on the TMHP website as www.tmhp.com, and will also be available in the 2008 May/June Texas Medicaid Bulletin, No. 215. 21 (02/22/08 through 03/14/08) *****Attention All Medicaid Dental Providers***** This is a correction to the 2008 Texas Medicaid Provider Procedures Manual, Section 19.15.5, "Restorative Services," on page 19-15. The reimbursement rate for procedure code D2390 when performed on primary anterior teeth is shown as $76.98. The correct reimbursement for procedure code D2390 on primary anterior teeth is $68.75. The reimbursement limitation for resin restorations is shown as $170.38 when performed on primary teeth. The correct amount is $156.06. The corrected paragraph is as follows: All fees for resin restorations on primary teeth are limited to $156.06, which is the fee for a stainless steel crown (exception: procedure code D2335). All fees for resin restorations on permanent teeth are limited to a total of $170.38 for posterior teeth and $170.38 for anterior teeth. Resin restoration includes composites or glass ionomer. 6 of 14

22 (02/15/08 through 03/07/08) *****Attention All Medicaid Dental Providers***** This is a correction to an article published on the TMHP website at www.tmhp.com on December 10, 2007, entitled Additional Oral Maxillofacial Procedure Codes To Be Benefits. The procedure code table referenced in the article did not include all the procedure codes that are payable to oral maxillofacial surgeons. The corrected article is available on the TMHP website at www.tmhp.com and will be published in the March/April 2008 Texas Medicaid Bulletin, No. 214. 23 (02/22/08 through 03/14/08) *****Attention All Medicaid Inpatient Hospital Providers***** This is an update to the November 2007 ICD-9-CM Special Bulletin, No. 211. The table entitled, "2008 New MS-DRGs," on page 13, included assigned DRG relative weights, mean lengths of stay (LOS), and day thresholds for new Medicare Severity-Diagnosis Related Group (MS-DRG) codes. HHSC has since updated the reimbursement information for 390 of the codes. Effective March 1, 2008, for dates of admission on or after October 1, 2007, 390 of the DRG relative weights have been revised. Day thresholds and mean lengths of stay remain unchanged. Claims submitted before March 1, 2008, with dates of admission on or after October 1, 2007, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. The updated information for affected MS-DRG codes and additional payment information effective for inpatient hospital admissions on or after October 1, 2007, is available in the TMHP website at www.tmhp.com. The updates will also be available in the May/June 2008 Texas Medicaid Bulletin, No. 215. 24 (02/29/08 through 03/21/08) *****Attention All Medicaid and PCCM Providers***** This is a correction to a banner message that was published on December 3, 2007, about an article entitled "Provider Name No Longer Listed on PCCM Medicaid ID Form." The message stated that details of the changes were available on the TMHP website at www.tmhp.com and in the March/April 2008 Texas Medicaid Bulletin, No. 212. The bulletin number was incorrect. The correct bulletin number is 214. For more information call the PCCM Provider Helpline at 1-888-834-7226 or the TMHP Contact Center at 1-800-925-9126. 25 (02/22/08 through 03/14/08) *****Attention All Medicaid and PCCM Providers***** This is an update to a banner message that first appeared on the January 25, 2008, Remittance and Status (R&S) report, and a website article that was posted on January 21, 2008, entitled "High Cost Durable Medical Equipment." The process has changed for recouping claims for which the DME Certification and Receipt Form has not been submitted to TMHP. Effective for dates of service on or after March 1, 2008, the revised DME Certification and Receipt Form must be submitted to TMHP for claims for durable medical equipment (DME) that meets or exceeds a billed amount of $2,500.00. The form must be submitted when multiple items that meet or exceed a total billed amount of $2,500.00 are billed for the same date of service. The form is required in addition to obtaining prior authorization, when applicable. 7 of 14

If the DME Certification and Receipt Form is not submitted to TMHP, the claim payment will be reviewed and will be eligible for recoupment. Incomplete forms will be returned to the provider for correction and resubmission. TMHP will also contact clients that received DME for verification of services rendered. If the delivery of the equipment can not be verified by the client, the claim payment will be eligible for recoupment. The revised DME Certification and Receipt Form is available on the TMHP website at www.tmhp.com and will be published in the May/June 2008 Texas Medicaid Bulletin, No. 215. The revised form may be submitted by fax to 512-506-6615 or submitted with the paper claim form. 26 (02/22/08 through 03/14/08) *****Attention All Medicaid and THSteps-CCP Providers***** This is an update to an article posted on the TMHP website on January 9, 2008, entitled, "Bariatric Surgery Benefits Now Available." The article stated that effective for dates of service on or after March 1, 2008, some bariatric surgical procedures are benefits of the Texas Medicaid Program. Bariatric surgery benefits will not be implemented on March 1, 2008. Providers will be informed in a future banner message when benefits for bariatric surgery become available. 27 (03/07/08 through 03/28/08) *****Attention All Inpatient Hospital Providers***** This is an update to an article posted on the TMHP website on February 18, 2008, entitled, "DRG Relative Weights Have Been Revised." Texas Medicaid Program health maintenance organizations (HMOs) are not required to reprocess claims retroactively for dates of admission on or after October 1, 2007. Texas Medicaid Program HMOs must use the revised weights for claims beginning on March 1, 2008. For the complete list of DRG relative weights, mean lengths of stay, and day thresholds, providers may refer to the article on the TMHP website entitled, "DRG Relative Weights Have Been Revised." 28 (03/07/08 through 03/28/08) *****Attention All MHMR Providers***** Effective April 26, 2008, for dates of service on or after January 1, 2005, TMHP will no longer reimburse claims submitted by Department of State Health Services (DSHS)- and Department of Aging and Disabilities Services (DADS)-certified providers for mental health rehabilitation, case management, and mental retardation services provided to clients in three client type programs. The funding to the centers received from DSHS and DADS agencies should be considered payment in full for these client categories. Claims for these individuals should no longer be submitted to TMHP. Centers are still responsible for providing appropriate services to clients without disruption. The type programs are: Type Program 9, Base Plan 32-Foster care clients who do not receive benefits through Temporary Assistance to Needy Families (TANF), medical assistance only, no federal match. Type Program 10, Base Plan 32-State-paid foster care clients, no federal match. Type Program 51, All Base Plans-State-paid Medical Assistance-Only (MAO) clients. 29 (02/29/08 through 03/21/08) *****Attention All THSteps-CCP Providers***** Effective immediately, providers must submit the THSteps-CCP Prior Authorization Request Form if they request a medically necessary service that is not addressed in the 2008 Texas Medicaid Provider Procedures 8 of 14

Manual for a client birth through 20 years of age. The THSteps-CCP Prior Authorization Request Form must be submitted to the Texas Medicaid & Healthcare Partnership, Attn: Comprehensive Care Program, PO Box 200735, Austin, Texas 78720-0555. It can also be faxed to 512-213-8877. 30 (02/22/08 through 03/14/08) *****Attention All Providers***** The Automated Inquiry System (AIS) will be enhanced March 20, 2008. The enhancements include the ability for providers to obtain a ticket number within the interactive voice response (IVR). The enhancements also include shortened menu prompt scripts to reduce the length of time a provider spends within the IVR. The enhancements to the AIS will improve the provider experience by improving self service within the IVR. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 31 (02/22/08 through 03/14/08) *****Attention All Providers***** Providers will soon be able to enroll in the Texas Medicaid Program and Children with Special Health Care Needs (CSHCN) Services Program and apply for Primary Care Case Management (PCCM) credentialing on the TMHP website at www.tmhp.com. Providers will have the following options: initial enrollment, reenrollment, credentialing, recredentialing, and provider information maintenance. The effective date will be published in a future banner message. Details are available on the TMHP website at www.tmhp.com. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 32 (02/15/08 through 03/07/08) *****Attention All Providers***** The state of Texas contingency period for National Provider Identifier (NPI) compliance has changed and will not end on February 29, 2008. HHSC and TMHP have extended the NPI contingency period through May 23, 2008. Providers must attest their NPIs and related data to TMHP by May 23, 2008. Related data includes a taxonomy code, a benefit code (if applicable), and a physical address with a ZIP Code+4. NPIs can be attested on the TMHP website at www.tmhp.com. Effective May 24, 2008, full NPI compliance will be implemented, and the contingency period will end. Providers that have not attested their NPIs and related data or that do not use their attested NPI and related data on all claims and other transactions (e.g., authorizations, eligibility verifications, and claim status inquiries) will experience the following: Rejection or denial of paper and electronic claims and other transactions. Returned authorization requests. Closed primary care provider panel reports (beginning April 1, 2008). The end of the contingency period will affect software and electronic data interchange (EDI): TDHconnect does not support the NPI, so claims and other transactions submitted using TDHconnect will be rejected. TDHconnect has been replaced by TexMedConnect, which is available on the TMHP website at www.tmhp.com. Third-party billers and software vendors must complete the mandatory EDI testing of NPI transactions or their transactions will be rejected. 9 of 14

Complete details are available on the TMHP website at www.tmhp.com and will be published in the 2008 March/April Texas Medicaid Bulletin, No. 214, and the 2008 May CSHCN Services Program Bulletin, No. 66. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 33 (03/07/08 through 03/28/08) *****Attention All THSteps Dental Providers***** TMHP has revised the THSteps Dental Mandatory Prior Authorization Request Form found in the 2008 Texas Medicaid Provider Procedures Manual. The updated form will be available on the TMHP website at www.tmhp.com on March 7, 2008, and will be published in the 2008 May/June Texas Medicaid Bulletin, No. 215. The updated form will also be available through the TMHP fax-back option through the Automated Inquiry System (AIS) at 1-800-925-9126. Effective May 1, 2008, TMHP will only accept the revised form. Prior authorization requests submitted on the old form will not be processed, and the provider will be notified to resubmit the request on the revised form. 34 (03/07/08 through 03/28/08) *****Attention All Medicaid and CSHCN Services Program Providers***** Respiratory syncytial virus (RSV) prophylaxis (procedure code 1-90378) is a benefit to eligible clients of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) and Children with Special Health Care Needs (CSHCN) Services Program when medically necessary. RSV prophylaxis can be provided through monthly injections of palivizumab (Synagis). Monthly injections of palivizumab are only medically necessary when the client will be exposed to widespread RSV activity in the community. In consultation with qualified experts, the Texas Medicaid Program and the CSHCN Services Program have been monitoring RSV activity across the state. Current surveillance trends document that RSV activity is rapidly waning. Based on these trends, RSV prophylaxis for this season will not be necessary in most areas of the state after March 31, 2008. Providers should communicate with their local hospitals or other qualified laboratories for information about RSV trends in their community so they can tailor palivizumab administration accordingly. Effective for dates of service on or after April 1, 2008, palivizumab is no longer medically necessary and will not be reimbursed without prior authorization. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 35 (02/29/08 through 03/21/08) *****Attention All Medicaid and CSHCN Services Program Providers***** This is a correction to the 2008 HCPCS Special Bulletin, No. 213. The bulletin incorrectly listed procedure code 1-S9152 as not covered by the Texas Medicaid Program or the Children with Special Health Care Needs (CSHCN) Services Program. Details about procedure code 1-S9152 are located on the 2008 HCPCS webpage of the TMHP website at www.tmhp.com and will be published in the May/June 2008 Texas Medicaid Bulletin, No. 215 and the May 2008 CSHCN Services Program Provider Bulletin, No. 66. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 10 of 14

36 (02/29/08 through 03/21/08) *****Attention All Medicaid and CSHCN Services Program Providers***** TMHP has identified an issue impacting claims submitted with dates of service on or after October 16, 2003, through February 8, 2008, and procedure code 1-97802 or 1-97803. Claims submitted with procedure code 1-97802 or 1-97803 and a quantity greater than one were inappropriately denied. Procedure codes 1-97802 and 1-97803 are limited to four units per rolling year for the same provider. One unit is equivalent to 15 minutes. Impacted claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 37 (02/29/08 through 03/21/08) *****Attention All Medicaid and CSHCN Services Program Providers***** TMHP has identified an issue impacting claims submitted with procedure code 3-99251, 3-99252, 3-99253, 3-99254, or 3-99255. For dates of service on or before December 31, 2006, these procedure codes were only valid for initial inpatient consultations and were limited to once every 30 days. Effective for dates of service on or after January 1, 2007, providers may bill these procedure codes for both new and established patient inpatient consultations. Claims submitted with dates of service on or after January 1, 2007, may have been denied in error. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Providers may refer to the 2008 Texas Medicaid Provider Procedures Manual, Section 36, or the 2008 Children with Special Health Care Needs Provider Manual, Chapter 24, for additional information on consultations and physician evaluation and management benefits. For more information, call the TMHP Contact Center at 1-800-925-9126 or the CSHCN Services Program Contact Center at 1-800-568-2413. 38 (2/15/08 through 3/7/08) *****Attention All Medicaid and CSHCN Services Program Providers***** On April 1, 2008, TMHP will implement first quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions effective for dates of service on or after April 1, 2008. Deleted procedure codes will no longer be benefits of the Texas Medicaid Program, Medicaid Managed Care Program, and Children with Special Health Care Needs (CSHCN) Services Program. Details of these changes will be available on the TMHP website at www.tmhp.com under the 2008 HCPCS webpage beginning April 1, 2008, and will also be included in the May/June 2008 Texas Medicaid Bulletin, No. 215 and the May 2008 CSHCN Provider Bulletin, No. 66. For more information, visit the TMHP website or call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413. 39 (02/22/08 through 3/14/08) *****Attention All Medicaid and CSHCN Services Program Dental Providers***** This is an update to the 2007 HCPCS Special Bulletin, No. 200, and also to the 2008 Texas Medicaid Provider Procedures Manual, Section 19.15.2, "Diagnostic Services," on page 19-10. The bulletin originally stated that effective for dates of service on or after January 1, 2007, procedure code D0145 is a benefit of the Texas 11 of 14

Medicaid Program and the Children with Special Health Care Needs (CSHCN) Services Program for dental providers. The updated information is as follows: Effective for dates of service on or after January 1, 2007, through February 29, 2008, procedure code D0145 is a benefit of the Texas Medicaid Program and the CSHCN Services Program and must complete the rate hearing process for an appropriate reimbursement rate to be established. Once the reimbursement rate is adopted, all claims submitted for reimbursement between January 1, 2007, and February 29, 2008, with procedure code D0145, will be reprocessed and payments adjusted accordingly. No further action on the part of the provider is necessary. Effective March 1, 2008, benefit requirements will change for procedure code W-D0145. Providers will be informed of these changes in a separate banner message. The information concerning procedure code D0145 in the 2008 CSHCN Services Program Provider Manual is correct and does not require an update. For more information, call the TMHP Contact Center at 1-800-925-9126, or the TMHP-CSHCN Contact Center at 1-800-568-2413. 40 (02/22/08 through 03/14/08) *****Attention All THSteps and CSHCN Services Program Dental Providers***** First Dental Home is a new initiative designed to help Texas Health Steps (THSteps) and Children with Special Health Care Needs (CSHCN) Services Program clients 6 months through 35 months of age to establish a dental home. Earlier oral evaluation allows earlier identification of dental needs and the start of needed preventive and therapeutic dental services. Dentists will be required to complete training and be certified to participate in the First Dental Home initiative. Effective for dates of service on or after March 1, 2008, dentists must be certified as First Dental Home providers in order to receive reimbursement for procedure code D0145. Procedure codes D0120, D0150, D1120, D1203, or D1206 will not be reimbursed if procedure code D0145 is billed with the same date of service by any provider. Certification as a First Dental Home provider will be added to the advanced search criteria of the online provider lookup on the TMHP website at www.tmhp.com. This change will enable users to find a dentist who is certified to provide this oral evaluation and counseling. The Texas Department of State Health Services (DSHS) will begin training and certifying currently-enrolled pediatric dental providers on or after March 1, 2008. Training for general dentists will begin on or after May 1, 2008. For more information about training, contact Dr. Linda Altenhoff at Linda.altenhoff@dshs.state.tx.us or 512-458-7111, Ext. 3001. 41 (02/22/08 through 03/14/08) *****Attention All CSHCN Services Program Providers***** TMHP has completed the National Provider Identifier (NPI) attestation for CSHCN Services Program providers who have completed the NPI attestation of their Texas Medicaid Program Texas Provider Identifier (TPI.) The NPI attestation was completed using the CSHCN Services Program TPI and the NPI, taxonomy code, and physical address provided during the NPI attestation with the Texas Medicaid Program. Providers are encouraged to review the information on the attestation page of the TMHP website at www.tmhp.com. If the information reflected in the NPI attestation is incorrect, providers must update the information on the attestation page. Access to the attestation page is granted through current administrative permissions. Only account administrators are able to attest and update online. 12 of 14

Transactions on the TMHP website, including claims filing and eligibility verifications, require the NPI and benefit code of those providers for whom the attestation has been completed. After attestation, the CSHCN Services Program and Texas Medicaid Program TPIs will no longer be accepted for transactions on the TMHP website. CSHCN Services Program transactions must include a benefit code. A benefit code is an additional data element that TMHP uses to identify state programs. "CSN" is used to identify the CSHCN Services Program. This benefit code is required on all claims and authorizations and will appear on paper checks when applicable. NPI information is available on the TMHP website under the NPI announcements page. For more information, call the TMHP CSHCN Services Program Contact Center at 1-800-568-2413. 42 (03/07/08 through 03/28/08) *****Attention All CSHCN Services Program Providers***** This is a correction to the 2008 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 213. The bulletin incorrectly indicated benefits and limitations for certain codes for the Children with Special Health Care Needs (CSHCN) Services Program. Details of these corrections are available on the 2008 HCPCS webpage at www.tmhp.com. The information will also be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 66. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 43 (02/22/2008 through 03/14/2008) *****Attention All CSHCN Services Program Providers***** This is a correction to an article posted on the TMHP website at www.tmhp.com on December 10, 2007, entitled "Additional Oral Maxillofacial Procedure Codes to be CSHCN Services Benefits". The procedure code table attached to in the article did not include all the procedure codes that are payable to oral maxillofacial surgeons. The complete, corrected article is available on the TMHP website at www.tmhp.com and will be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 61. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 44 (02/15/08 through 03/07/08) *****Attention All CSHCN Services Program Providers***** Effective for dates of service on or after April 1, 2008, benefit criteria for chemotherapy services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Details of these changes are available on the TMHP website at www.tmhp.com and will be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 66. For more information, call the TMHP Contact Center at 1-800-568-2413. 45 (2/15/08 through 3/7/08) *****Attention All CSHCN Services Program Providers***** Effective for dates of service on or after April 1, 2008, electrodiagnostic testing (electromyography [EMG] and nerve conduction studies [NCS]) services are benefits of the Children with Special Health Care Needs (CSHCN) Services Program. EMG and NCS services are limited to four occurrences/visits per calendar year when submitted for reimbursement by the same provider. Prior authorization will not be considered beyond the four occurrences. Additional nerve conduction studies per occurrence may be considered for prior authorization with documentation of medical necessity. EMG and NCS procedure codes are diagnosis restricted. Additional details of these new benefits are available on the TMHP website at www.tmhp.com and will also be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 66. 13 of 14

For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 46 (03/07/08 through 03/28/08) *****Attention All CSHCN Services Program DME Providers***** Effective February 27, 2008, for dates of service on or after December 1, 2006, the rates changed for some durable medical equipment (DME) procedure codes. Effective February 22, 2008, for dates of service on or after October 1, 2006, the rates changed for procedure codes J/L-K0010 and J/L-K0011. Claim reprocessing information and a complete list of procedure codes with updated reimbursement rates is available on the TMHP website at www.tmhp.com and will be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 66. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. 14 of 14