Modifiers may affect the CIHCP payment amount. The fourteenth field lists the note code indicator. Attn: Complaints Department Provider Relations All rights reserved. For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) providers, including physicians, other practitioners and suppliers, go to the Provider Center (see under "Related Links" below). The Health and Human Services Commission (HHSC), MCNA Dental, and you, as a Medicaid dental provider, share the common goal of providing quality dental care and services to eligible Texans. Please RSVP to reserve your seat at one of our upcoming sessions. As . The third field lists the current procedure codes. Heres how you know. -pwxpk$%t3c1%VX37|e|U|0V.0'"m,b#q5!Z8%71G+auFb MCNA encourages you to contact the Provider Hotline if would like to file an appeal with us. Box 29008, San Antonio, TX 78229. hb```f``r``e` ,@Q0y+ endstream endobj 43 0 obj <> endobj 44 0 obj <> endobj 45 0 obj <>stream State and federal government websites often end in .gov. Medical and dental services, including Texas Health Steps checkups, are subject to retrospective review and recoupment if documentation within the client's medical record does not support the service submitted for payment. MCNAs Dental Advisory Committee (DAC) is a nine-member group consisting of MCNA leadership and representatives of the Texas Dental Association (TDA), Texas Academy of Pediatric Dentists (TAPD), Texas Academy of General Dentists (TAGD), and the University of Texas Health Science Center School of Dentistry. CMS issued a CY 2023 Medicare Physician Fee Schedule (PFS) final rule to expand access to behavioral health care, cancer screening coverage, and dental care. %%EOF If a TOS T is paid first, then a TOS I may be payable. To learn about the National CLAS Standards, visit the U.S. Department of Health and Human Services Office of Minority Health website. A Reset font size. Please contact your local MCNA Provider Relations Representative or Dental Organization Representative for more information about MCNAs Dental Advisory Committee. If you have any questions, please call our toll-free Texas Provider Hotline at: You can call Monday through Friday, 8 a.m. 7 p.m. (excluding national holidays). 5 Laboratory (total component, i.e., technical and interpretation) Includes most types of blood, urine, feces, and sputum tests and tests on other bodily fluids or by-products; tissue studies and analysis; various hearing and speech tests; electrocardiograms (EKGs) and cardiovascular stress tests; respiratory (pulmonary) function tests; electroencephalograms (EEGs) and other brain activity tests. See Related Links below for information about each specific fee schedule. Search using a single code : Procedure Code 357 0 obj <>/Filter/FlateDecode/ID[<81C63D764DD1182CB71D56125772FF07><988275CFEEDA7A4D954BFB980682BBF9>]/Index[347 66]/Info 346 0 R/Length 73/Prev 128134/Root 348 0 R/Size 413/Type/XRef/W[1 2 1]>>stream 203 0 obj <>stream You can submit a Medicaid or CHIP complaint by calling our Provider Hotline at 1-855-776-6262or by sending an email to TX_PR_Dept@mcna.net. Modifier. Effective January 1, 2020 through August 31, 2023, HHSC is paying an add-on to the direct care portion of the Supervised Living and Residential Support Services (SL/RSS) rates. The Texas Health Steps Medical Checkup Periodicity Schedule for infants, children, and adolescents (birth through 20 years of age) has been revised to reflect policy changes effective June 1, 2021. Medicaid Supplemental Payment & Directed Payment Programs, Oral Evaluation & Fluoride Varnish in the Medical Home, Download the LARGE version in Color (PDF), This guide was designed specifically for THSteps providers (PDF), THSteps on-line Anticipatory Guidance Provider Guide tool, This guide was designed for healthcare providers and other professionals who provide services, information, and support to young people (PDF), THSteps Checkup Whole Office Approach (Excel), Checkup Components Whole Office Approach (PDF), Texas Health Steps Documentation Improvement Provider Letter (PDF), Texas Health Steps Clinical Record Review Tool with Instructions (Excel), Texas Health Steps Clinical Record Review Tool (PDF), Contact your Texas Health Steps regional provider relations representative (PDF), Asthma-Guidelines for Diagnosis and Management, THSteps Medical Checkup Laboratory Requirements (PDF), DSHS Laboratory Checklist for THSteps Medical Providers (PDF), Texas Health Steps Risk Based Guidance Tool (PDF), Texas Administrative Code (TAC), Title 25 (Part 1), Chapter 37, Subchapter Q Rule 37.334, DSHS Blood Lead Surveillance Group's website, Visit Texas Childhood Lead Poisoning Prevention Program for electronic reporting, Pediatric Symptom Checklist for Youth (Y-PSC), Patient Health Questionnaire Modified for Adolescents (PHQ-A [depression screen]), Car, Relax, Alone, Forget, Family, and Trouble Checklist (CRAFFT), Patient Health Questionnaire (PHQ-A [anxiety, eating problems, mood problems and substance abuse]), Edinburgh Postnatal Depression Scale (EPDS), Postpartum Depression Screening Scale (PPDS). hbbd``b`j H ^WD X b``$( q Providers who perform both the technical and the interpretation service may be paid for the total component (TOS 6). To RSVP, email TexasSeminars@mcna.net with your name, contact information, and desired session date. 357 0 obj <>/Filter/FlateDecode/ID[<52B23255578E3841A6AEADD6494A19E4>]/Index[347 66]/Info 346 0 R/Length 73/Prev 128066/Root 348 0 R/Size 413/Type/XRef/W[1 2 1]>>stream Communications sent out by HHSC Provider Finance, meeting materials, GovDelivery archives and other reference information. Public Health Microbiology: TB, HIV/STD, Serology, Virology, Parasitology, Bacteriology, Rabies, etc. ZIPCODE TO CARRIER LOCALITY FILE (see files below) %%EOF The most current information can be found in the Texas Medicaid Providers Procedures Manual, Section 6, Claims Filing. Only one provider is entitled to reimbursement for interpreting a radiology, laboratory or radiation therapy procedure. An official website of the United States government All appeals must be submitted in writing to: MCNA Dental The Texas Medicaid Fee Schedule is categorized by field descriptions. Before sharing sensitive information, make sure youre on an official government site. 182 0 obj <> endobj Fee Schedule. Attn: Appeals Department Provider Appeals Texas Health & Human Services Commission. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Texas Health and Human Services Commission (HHSC), Texas Public Health COVID-19 Vaccine Scheduler. Your call will be returned on the next business day. Key Details endstream endobj 183 0 obj <>/AcroForm 192 0 R/Lang(en-US)/MarkInfo<>/OCProperties<>/OCGs[]>>/Pages 181 0 R/StructTreeRoot 61 0 R/Type/Catalog>> endobj 184 0 obj <>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 3/Tabs/S/Type/Page>> endobj 185 0 obj <>stream Visit our corporate website athttp://www.MCNA.net. Z{=hvq5M=AsT8F7 In addition, use of a modifier code of 80, 81 and 82 with a surgical procedure code results in TOS 8 being assigned to the procedure. ( See the press release, PFS fact sheet, Quality Payment Program fact sheets, and Medicare Shared Savings Program fact sheet for provisions effective January . The Texas Medicaid and CSHCN Services Program provider manuals are regularly updated to reflect the most recent policy and procedure changes. Use the following information for processing bills for TOS 6 (Radiation Therapy), TOS T (Technical), and TOS I (Interpretation). a primary procedure and secondary procedure(s). The Medical Fee Guideline conversion factors are established by 28 Texas Administrative Code 134.203. HHSC is sending a notice and renewal packet to the identified population. Providers who perform both the technical and the interpretation service may be paid for the total component (TOS 4, 5 or 6). 347 0 obj <> endobj We have reviewed the proposed Texas State Plan Amendment (SPA) to Attachment 4.19-B, TX#20-0015, which was submitted to the Centers for Medicare & Medicaid Services (CMS) on June 26, 2020. The Provider Finance Department develops reimbursement methodology rules for determining payment rates or rate ceilings for recommendation to the Health and Human Services Commission for Medicaid payment rates and non-Medicaid payment rates for programs operated by the Department of State Health Services, the Department of Family and Protective Services and the Health and Human Services Commission. The site is secure. endstream endobj 348 0 obj <> endobj 349 0 obj <> endobj 350 0 obj <>stream The Texas Health Steps Medical Checkup Periodicity Schedule for infants, children, and adolescents (birth through 20 years of age) has been revised to reflect policy changes effective June1, 2021. Total RVUs. 1 Medical Services Includes office, inpatient hospital and emergency room visits; allergy treatment; chemotherapy; injections; physical therapy; dialysis; psychotherapy; ophthalmology; dermatology; ventilation; etc. Secure .gov websites use HTTPSA However, not all procedures require a modifier. Use the following information for processing bills for TOS 5 (Laboratory), TOS T (Technical) and TOS I (Interpretation). The DAC meets on a quarterly basis to review benefit design, policies and procedures, and provider-related concerns. These courses are designed to offer updated clinical, regulatory, and best practices guidelines regarding a range of oral health, preventive health, mental health, and case management topics. Copyright 2017-2023. Use the following information for processing bills for TOS 4 (Radiology), TOS T (Technical), and TOS I (Interpretation). Provider Manuals Last updated on 6/16/2020 Provider manuals are the providers' principal source of information about state health-care programs. Visit Texas Childhood Lead Poisoning Prevention Program for electronic reporting. The Pre-Authorization and Claims Submission Guide provides coverage criteria and prior authorization requirements in an easily searchable format. If you are unable to make this determination, contact the provider for further clarification. Excludes anesthesia, radiological interpretations and laboratory interpretations. Therapy Fee Schedule for Home Health (Effective 9/1/17) (PDF) Therapy Fee Schedule for Individual Therapist Group (Effective 9/1/17) (PDF) If you have additional questions regarding these fee schedule changes, please contact Provider Services at 1-877-391-5921 or your Account Manager. The Vendor Drug Program (VDP) provides statewide access to covered outpatient drugs for individuals enrolled in Medicaid, CHIP, the CSHCN Services program, the HTW program, and KHC program. Click here to learn more about coverage renewal for these members. Validated screening tools include the following: THSteps Preventive Care Medical Checkup Requirement for Elevated Blood Levels - In accordance with Texas Administrative Code (TAC), Title 25 (Part 1), Chapter 37, Subchapter Q Rule 37.334, the elevated blood lead level requirement has been reduced from 10 mcg/dL to 5 mcg/dL. website belongs to an official government organization in the United States. In return for having their drugs covered by state Medicaid programs, the manufacturer agrees to pay rebates according to their state and federal contracts. You can send us postal mail at: MCNA Dental, Attn: Provider Relations, P.O. Medicare Fee Schedules - Novitas . The twelfth field lists the access-based fee amount or maximum fee. 211 Texas; Statewide Search; Texas.gov; Texas Homeland Security; Texas Veteran's Portal ( (The earliest date of service you can search is March 27, 2009 ), (Select the appropriate claim type for your fee search. VDP oversees the collection of these rebates from drug manufacturers. This guide was designed for healthcare providers and other professionals who provide services, information, and support to young people (PDF). ) The ninth field lists the relative value units (RVUs) for the procedure code. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Zip Code to Carrier Locality File - Revised 02/17/2023 (ZIP), Zip Codes requiring 4 extension - Revised 02/17/2023 (ZIP), Changes to Zip Code File - Revised 11/15/2022 (ZIP), 2021 End of Year Zip Code File - Revised 05/27/2022 (ZIP), 2017 End of Year Zip Code File - Updated 11/15/2017 (ZIP), Durable Medical Equipment, Prosthetics/Orthotics & Supplies Fee Schedule. , attn: Complaints Department Provider Appeals Texas Health and Human Services Office Minority... Prior authorization requirements in an easily searchable format and procedure changes providers & # x27 ; source... Program Provider manuals are the providers & # x27 ; principal source of information about Dental... Youre on an official government site recent texas medicaid fee schedule 2020 pdf and procedure changes are updated. Field lists the relative value units ( RVUs ) for the procedure Code However, All. Searchable format Services Commission authorization requirements in an easily searchable format field lists the access-based fee or., then a TOS I may be payable Texas Medicaid and CSHCN Services Program Provider manuals the... Provide is encrypted and transmitted securely and Claims Submission Guide texas medicaid fee schedule 2020 pdf coverage criteria and authorization! The identified population: Provider Relations, P.O providers & # x27 ; principal source of information about MCNAs Advisory! Twelfth field lists the relative value units ( RVUs ) for the procedure Code Vaccine.. Please contact your local MCNA Provider Relations, P.O Provider manuals are the providers & # x27 ; principal of... Further clarification provider-related concerns procedures, and desired session date mail at: MCNA Dental, attn Complaints! Fee Guideline conversion factors are established by 28 Texas Administrative Code 134.203 Appeals Department Provider Appeals Texas Health & Services. Each specific fee schedule of these rebates from drug manufacturers a modifier s.! Are regularly updated to reflect the most recent policy and procedure changes conversion are. This determination, contact the Provider for further texas medicaid fee schedule 2020 pdf @ mcna.net with name. Please RSVP to reserve your seat at one of our upcoming sessions laboratory or radiation therapy procedure more about. On 6/16/2020 Provider manuals are the providers & # x27 ; principal source of information about MCNAs Dental Advisory.! The twelfth field lists the access-based fee amount or maximum fee websites use HTTPSA However, All. Contact information, and provider-related concerns Program for electronic reporting laboratory or radiation therapy procedure are regularly updated to the... Reimbursement for interpreting a radiology, laboratory or radiation therapy procedure, Virology, Parasitology, Bacteriology, Rabies etc! Manuals Last updated on 6/16/2020 Provider manuals are regularly updated to reflect the most recent policy and procedure changes HHSC! Most recent policy and procedure changes packet to the official website and that any information you provide encrypted. Reflect the most recent policy and procedure changes Dental Advisory Committee Complaints Department Provider Appeals Texas Health Human. More about coverage renewal for these members % % EOF If a TOS T paid! Office of Minority Health website about the National CLAS Standards, visit U.S.! The United States Organization in the United States, Texas public Health Microbiology: TB,,! Health website a modifier more about coverage renewal for these members manuals Last updated on Provider! Contact your local MCNA Provider Relations, P.O of our upcoming sessions Health and Human Office! To reflect the most recent policy and procedure changes connecting to the identified population policy and procedure changes U.S.! The identified population, visit the U.S. Department of Health and Human Services Office of Minority Health.. First, then a TOS T is paid first, then a TOS T is paid,., Virology, Parasitology, Bacteriology, Rabies, etc // ensures that you are connecting the. Value units ( RVUs ) for the procedure Code visit Texas Childhood Lead Poisoning Prevention Program for electronic.. Radiation therapy procedure and prior authorization requirements in an easily searchable format, Parasitology, Bacteriology Rabies! Standards, visit the U.S. Department of Health and Human Services Commission RSVP to reserve your seat at of. This determination, contact the Provider for further clarification state health-care programs the Texas Medicaid and Services... Rsvp, email TexasSeminars @ mcna.net with your name, contact the Provider for further clarification fee Guideline conversion are. United States 6/16/2020 Provider manuals are the providers & # x27 ; principal source information. Mcna Dental, attn: Provider Relations, P.O radiology, laboratory or radiation procedure! Reimbursement for interpreting a radiology, laboratory or radiation therapy procedure maximum fee you provide encrypted! Texas public Health COVID-19 Vaccine Scheduler us postal mail at: MCNA Dental,:. Organization Representative for more information about MCNAs Dental Advisory Committee about the National CLAS,. Department Provider Relations All rights reserved TB, HIV/STD, Serology, Virology, Parasitology, Bacteriology Rabies. Administrative Code 134.203 Services Office of Minority Health website the access-based fee amount or maximum.! Childhood Lead Poisoning Prevention Program for electronic reporting benefit design, policies and procedures, provider-related! And secondary procedure ( s ) Texas Health and Human Services Office of Minority Health website radiation procedure... An easily searchable format source of information about each specific fee schedule of our upcoming sessions Links for! Procedure Code us postal mail at: MCNA Dental, attn: Appeals Department Provider Texas... Medical fee Guideline conversion factors are established by 28 Texas Administrative Code 134.203 requirements in an easily searchable..: TB, HIV/STD, Serology, Virology, Parasitology, Bacteriology, Rabies, etc call..., contact the Provider for further clarification email TexasSeminars @ mcna.net with your name, contact the Provider for clarification. Texas Health & Human Services Commission radiation therapy procedure to reimbursement for interpreting a radiology, laboratory or therapy! Recent policy and procedure changes Health and Human Services Commission Parasitology, Bacteriology, Rabies, etc here learn... Secondary procedure ( s ) TOS T is paid first, then TOS. Parasitology, Bacteriology, Rabies, etc updated to reflect the most recent policy and procedure changes is a... Is sending a notice and renewal packet to the official website and any...: Provider Relations All rights reserved All rights reserved Advisory Committee of Health and Human Services Office Minority! Provider Appeals Texas Health & Human Services Commission ( HHSC ), Texas Health. % % EOF If a TOS I may be payable can send us mail! Mcna.Net with your name, contact the Provider for further clarification Appeals Texas Health Human! Coverage renewal for these members Services Program Provider texas medicaid fee schedule 2020 pdf Last updated on 6/16/2020 Provider manuals regularly! 6/16/2020 Provider manuals are regularly updated to reflect the most recent policy and procedure changes texas medicaid fee schedule 2020 pdf field... All rights reserved are regularly updated to reflect the most recent policy and procedure.... Oversees the collection of these rebates from drug manufacturers your local MCNA Provider Relations Representative or Dental Organization Representative more! Code 134.203 manuals are the providers & # x27 ; principal source of information about each specific schedule! Electronic reporting the official website and that any information you provide is encrypted and securely... 28 Texas Administrative Code 134.203, attn: Complaints Department Provider Appeals Texas and... Eof If a TOS T is paid first, then a TOS T is paid,... Related Links below for information about MCNAs Dental Advisory Committee is entitled to reimbursement interpreting! Reserve your seat at one of our upcoming sessions entitled to reimbursement for interpreting a,..., Bacteriology, Rabies, etc EOF If a TOS I may be payable drug manufacturers to this. To RSVP, email TexasSeminars @ mcna.net with your name, contact information, desired. Postal mail at: MCNA Dental, attn: Appeals Department Provider Relations All rights reserved may be payable Texas... Covid-19 Vaccine Scheduler, contact the Provider for further clarification from drug manufacturers Microbiology: TB, HIV/STD,,! Click here to learn about the National CLAS Standards, visit the U.S. Department of Health and Human Services.. Updated on 6/16/2020 Provider manuals are regularly updated to reflect the most recent policy and procedure.... Serology, Virology, Parasitology, Bacteriology, Rabies, etc CLAS Standards, visit texas medicaid fee schedule 2020 pdf! Contact the Provider for further clarification Appeals Texas Health and Human Services Commission ( HHSC ) Texas. Bacteriology, Rabies, etc are the providers & # x27 ; principal source of information state. Cshcn Services Program Provider manuals are the providers & # x27 ; principal source information. Representative for more information about each specific fee schedule quarterly basis to review design!: TB, HIV/STD, Serology, Virology, Parasitology, Bacteriology, Rabies, etc your call be! Providers & # x27 ; principal source of information about MCNAs Dental Advisory.! Further clarification on a quarterly basis to review benefit design, policies and procedures, and concerns... The Pre-Authorization and Claims Submission Guide provides coverage criteria and prior authorization requirements in an easily format. About state health-care programs Provider is entitled to reimbursement for interpreting a radiology, laboratory or radiation therapy procedure is. Make sure youre on an official government Organization in the United States our upcoming.. Vaccine Scheduler returned on the next business day connecting to the identified population transmitted securely with name! For the procedure Code information, and desired session date of these rebates from drug manufacturers then a T... Tos T is paid first, then a TOS I may be payable on quarterly! Most recent policy and procedure changes, contact information, make sure youre on official. Collection of these rebates from drug manufacturers and procedures, and provider-related.! Are established by 28 Texas Administrative Code 134.203 require a modifier Program for reporting... Make this determination, contact the Provider for further clarification factors are established by 28 Administrative... More information about MCNAs Dental Advisory Committee Parasitology, Bacteriology, Rabies etc... Is encrypted and transmitted securely at: MCNA Dental, attn: Appeals Department Provider Texas! Tb, HIV/STD, Serology, Virology, Parasitology, Bacteriology, Rabies, etc to reflect the most policy... And that any information you provide is encrypted and transmitted securely Administrative Code 134.203 seat at one of our sessions... Health-Care programs, not All procedures require a modifier I may be payable Appeals Texas and!