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2019 TMPPM Release Notes

Last updated on 9/11/2020

The following tables show the section and handbooks that were changed in the Texas Medicaid Provider Procedures Manual in 2019. The changes are listed in reverse chronological order (newest first).

For changes made in 2018, see the 2018 Release Notes.

December 2019 Release Notes
Handbook	Related Articles and Notes
Behavioral Health and Case Management Services Handbook	Notes: Updated URL links in section 3, “Case Management for Children and Pregnant Women.”
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)	Notes: In section 2.10.1, “Enrollment,” and 2.10.2, “Services, Benefits, and Limitations,” updated and replaced Texas State Board of Examiners of Dietitians to reflect the correct organization name of Texas Department of Licensing and Regulation (TDLR). In section 3.3.9.3, “Provider and Supervision Requirements,” updated and replaced State Board of Examiners for Speech- Language Pathology and Audiology to reflect the correct organization name of Texas Department of Licensing and Regulation (TDLR).
Clinician-Administered Drugs (CAD) Handbook	Related Articles: Eteplirsen to become a Benefit in the Home Setting Effective December 1, 2019 Information posted October 25, 2019 Update to TMPPM for Clinician-Administered Drugs Hematopoietic Injection Limitation Information posted October 25, 2019 Age Limitation to Change for Mepolizumab Effective December 1, 2019 Information posted October 25, 2019 Update to ‘Onasemnogene Abeparvovec-xioi (Zolgensma) Criteria Effective October 1, 2019, for Texas Medicaid’ Information posted November 22, 2019
Clinics and Other Outpatient Facility Services Handbook	Related Articles: Parsabiv Drug to be Included in Method I Composite Rate for Renal Dialysis Facilities Information posted November 15, 2019
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Related Articles: Clarification for Pediatric Hospital Bed Benefits Information posted November 27, 2019 Notes: Added introduction statement to table in subsection, 2.2.16.30, “Procedure Codes and Limitations for Mobility Aids.” Added clarifying statement regarding age limitations to subsection, 2.2.17 “Nutritional (Enteral) Products, Supplies, and Equipment.”
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Notes: In section 3.1, “Provider Enrollment,” added American Midwifery Certification Board (AMCB) to indicate the board that is responsible for the certification requirements of CNMs. In section 6.1, “Provider Enrollment,” updated and replaced Texas Midwifery Board to reflect the correct organization name of Texas Department of Licensing and Regulation (TDLR). Edits made to statement in section 9.2.2.1, “Teaching Physician Prerequisites,” to clarify supervision requirements for teaching physicians in reference to the Graduate Medical Education (GME) program.
Radiology and Laboratory Services Handbook	Notes: Added subsection regarding documentation requirements to section 2.2.8, “Drug Testing and Therapeutic Drug Assays.”

November 2019 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities	Update to Timeframe Requirements for Provider Maintenance Files Information posted October 24, 2019
Volume 1: Section 4: Client Eligibility	Revised language regarding private health insurance in section 4.7, “Healthy Texas Women (HTW) Program.”
Volume 1: Section 6: Claims Filing	Update Regarding Attending Provider NPI Requirements for Outpatient Claim Submissions Information posted October 18, 2019 Services Rendered by a Substitute Dentist May Be Billed to TMHP Utilizing Modifier U5, Effective Jan. 1, 2018 Information posted November 17, 2017 Updated subsection 6.7.4, “ADA Dental Claim Form Instruction Table” to align with current instructions. Replaced Coordination of Benefits Contractor (COBC) references with “Benefit Coordination and Recovery Center (BCRC)” to align with the new entity name. Corrected the claims filing deadline date for Thanksgiving and the day after Thanksgiving in subsection 6.1.4, “Claims Filing Deadlines.”
Volume 1: Section 8: Third Party Liability (TPL)	Removed Medicare language from section 8.4, “Non-TPR Sources.”
Behavioral Health and Case Management Services Handbook	2019 ICD-10 Special Bulletin No.16 Information posted September 30, 2019 Medication Assisted Treatment Benefits to Change for Texas Medicaid November 1, 2019 Information posted September 13, 2019
Children’s Services Handbook: THSteps Dental services (Section 4)	Clarification of Dental Exception-to-Periodicity Modifiers for Texas Health Steps Dental Services Effective November 1, 2019 Information posted September 9, 2019
Clinician-Administered Drugs (CAD) Handbook	Third Quarter 2019 HCPCS Updates for Texas Medicaid Information posted September 27, 2019 Esketamine (Spravato) to Become a Benefit of Texas Medicaid Effective October 1, 2019 Information posted October 11, 2019
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Updated subsection 2.1.2.1, “Proof of Continuation,” to add Provider Information Management System (PIMS) language to submission information for surety bonds. 2019 ICD-10 Special Bulletin No. 16 Information posted September 30, 2019
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook	Removed IUD LARC language from subsection 2.2.5.2.1, “Long Acting Reversible Contraception: Intrauterine Devices.”
Inpatient and Outpatient Hospital Services Handbook	Removed language regarding addresses on neonatal claim submissions in, subsection 3.7.3.7, “Other Requirements.” 2019 ICD-10 Special Bulletin No. 16 Information posted September 30, 2019
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Revised the title of Section 9.2.5.2.3, “Prior Authorization for Collagen Skin Tests” to “Prior Authorization,” as the section contains information regarding both allergy testing and collagen skin tests. 2019 ICD-10 Special Bulletin No. 16 Information posted September 30, 2019 Benefit Changes for Clubfoot Casting Services Effective October 1, 2019 Information posted September 20, 2019 Third Quarter 2019 HCPCS Updates for Texas Medicaid Information posted September 27, 2019
Radiology and Laboratory Services Handbook	Updated subsection 3.1.1, “Enrollment Criteria for Mammography Providers,” to add Provider Information Management System (PIMS) to the submission process for mammography certifications.
Vision and Hearing Services Handbook	Removed “calendar” from procedure code statement in subsection 2.2.3.7, “Limitations.” 2019 ICD-10 Special Bulletin No. 16 Information Posted September 30, 2019
Women’s Health Services Handbook	Revised language regarding private health insurance in section 2.1, “Guidelines for HTW Providers.”

October 2019 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities	Updated 10 business day references to 30 days for changes related to ownership. Added new subsection “Medicare Overpayment” with language regarding withholding Medicare overpayments.
Volume 1: Section 4: Client Eligibility	More Detailed View of Client Eligibility Information Coming to My Account on Client Portal Information posted August 20, 2019
Volume 1: Section 5: Fee-for-Service Prior Authorizations	More Detailed View of Client Eligibility Information Coming to My Account on Client Portal l Information posted August 20, 2019
Volume 1: Section 6: Claims Filing	More Detailed View of Client Eligibility Information Coming to My Account on Client Portal Information posted August 20, 2019
Volume 1: Section 8: Third Party Liability (TPL)	More Detailed View of Client Eligibility Information Coming to My Account on Client Portal Information posted August 20, 2019
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), THSteps Dental services (Section 4), and Appendix D: Texas Health Steps Statutory State Requirements	Updated the Code of Federal Regulations (CFR) rule 34 CFR §300.136(a) (1) in subsection 3.3.3.1, “Psychological Testing,” and changed to 42 CFR §440.60(a). More Detailed View of Client Eligibility Information Coming to My Account on Client Portal Information posted August 20, 2019 Updated language in appendix section 4.2.1.2, “Parental Accompaniment,” to be consistent with the legally-approved parental accompaniment language.
Clinician-Administered Drugs (CAD) Handbook	Onasemnogene Abeparvovec-xioi (Zolgensma) Criteria Effective October 1, 2019, for Texas Medicaid Information posted September 6, 2019
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	More Detailed View of Client Eligibility Information Coming to My Account on Client Portal Information posted August 20, 2019
Home Health Nursing and Private Duty Nursing Services Handbook	More Detailed View of Client Eligibility Information Coming to My Account on Client Portal Information posted August 20, 2019
Inpatient and Outpatient Hospital Services Handbook	Lutetium Lu 177 dotatate (Lutathera) to become a Benefit of Texas Medicaid Effective June 1, 2019 Information posted September 6, 2019
Medicaid Managed Care Handbook	More Detailed View of Client Eligibility Information Coming to My Account on Client Portal Information posted August 20, 2019
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Lutetium Lu 177 dotatate (Lutathera) to become a Benefit of Texas Medicaid Effective June 1, 2019 Information posted September 6, 2019
Vision and Hearing Services Handbook	More Detailed View of Client Eligibility Information Coming to My Account on Client Portal Information posted August 20, 2019
Women’s Health Services Handbook	More Detailed View of Client Eligibility Information Coming to My Account on Client Portal Information posted August 20, 2019

September 2019 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities	Updated language for certain documentation that providers can update through the Provider Information Management System (PIMS).
Volume 1: Section 6: Claims Filing	Removed language regarding TPI requirements for Change of Ownership. Updated Version of the American Dental Association Claim Form Now Available Information posted August 30, 2019
Volume 1: Section 8: Third Party Liability (TPL)	Updated Version of the American Dental Association Claim Form Now Available Information posted August 30, 2019
Ambulance Services Handbook	Correction to ‘Prior Authorization Requirements and Instructions Update for Ambulance Transportation Services’ Information posted June 21, 2019
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), and Appendix A: THSteps Forms	Updated Version of the American Dental Association Claim Form Now Available Information posted August 30, 2019
Clinician-Administered Drugs (CAD) Handbook	Clinician-Administered Drugs Procedure Code J0606 No Longer a Benefit Effective October 1, 2018 Information posted July 19, 2019 Added Payable Diagnosis Code and Age Restriction Change for Panhematin Procedure Code J1640 Information posted August 2, 2019 Second Quarter 2019 HCPCS Updates for Texas Medicaid Information posted July 19, 2019
Clinics and Other Outpatient Facility Services Handbook	Update to TMPPM Clinics and Other Outpatient Facility Services Handbook Information posted August 23, 2019 Clinician-Administered Drugs Procedure Code J0606 No Longer a Benefit Effective October 1, 2018 Information posted July 19, 2019 Updated Version of the American Dental Association Claim Form Now Available Information posted August 30, 2019
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Removed typo “1” in section 2.2.16.24.1, “Prior Authorization.”

August 2019 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities	Removed link in section 1.12, “Forms.” Meaningful user Attestation Instructions-Stage 1 form is no longer in use.
Volume 1: Section 8: Third Party Liability (TPL)	Updated section 8.3, “TPR Sources,” to add Specialized Skills Training (SST) language regarding ECI.
Volume 1: Appendix D: Acronym Dictionary	Removed acronym Global Assessment of Functioning (GAF) from table in section D.1, “Acronym Dictionary.”
Behavioral Health and Case Management Services Handbook	Updated the table in section 9.6, “Outpatient Treatment Services,” to add Diagnosis codes F10951, F1223, F1293 & F553. Added language regarding POS in section 4, “Outpatient Mental Health Services.”
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), and THSteps Dental services (Section 4)	Replaced broken link in Section 3.1.1, “Random Moment Time Study (RMTS),” with valid link https://rad.hhs.texas.gov/time-study/time-study-independent-school-districts-isd. Updated language in sections 5.3.11.3, “Immunizations,” and 5.5.1, “Claims Information,” to clarify when diagnosis code Z23 should be applied to vaccines. Update to TMPPM Children’s Services Handbook for Dental General Anesthesia Information posted July 12, 2019
Clinician-Administered Drugs (CAD) Handbook	Moxetumomab pasudotox-tdfk (Lumoxiti) Procedure Code C9045 is a Benefit of Texas Medicaid Effective August 1, 2019 Information posted June 14, 2019 Second Quarter 2019 HCPCS Updates for Texas Medicaid Information posted July 19, 2019
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Mobility Aid Benefits to Change for Texas Medicaid August 1, 2019 Information posted July 8, 2019
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook	Removed section 6.11, “Abortions” from handbook and moved G7 Modifier language and section 6.11.1, “Services Related to Abortion Procedures” to section 4.1.6, “Abortions.”
Inpatient and Outpatient Hospital Services Handbook	Removed AXIS language in subsection 3.4.5, “Medicaid Clinical Criteria for Inpatient Psychiatric Care for Clients.”
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Update to TMPPM for Evoked Potential Testing Information posted July 26, 2019 Updated language in sections 9.2.37, “Immunizations for Clients Who Are 21 Years of Age and Older,” to clarify when diagnosis code Z23 should be applied to vaccines. Second Quarter 2019 HCPCS Updates for Texas Medicaid Information posted July 19, 2019
Telecommunication Services Handbook	Telehealth Services Benefit Policy Updated Effective August 1, 2019 Information posted June 14, 2019

July 2019 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 6: Claims Filing	TMHP to Update National Place of Service Code Value 57 Information posted May 20, 2019 Deactivated NCCI MUE Limitations for Substance Use Disorder Treatment and Breast Pump Replacement Parts Information posted May 31, 2019
Volume 1: Appendix A: State, Federal, and TMHP Contact Information	Updated subsection A.12.3 “Automated Inquiry System (AIS)” to remove language regarding AIS user guide.
Behavioral Health and Case Management Services Handbook	Delegated Psychological Services to Allow More Than One Modifier on the Same Date of Service Effective July 1, 2019 Information posted May 17, 2019 Deactivated NCCI MUE Limitations for Substance Use Disorder Treatment and Breast Pump Replacement Parts Information posted May 31, 2019
Clinician-Administered Drugs (CAD) Handbook	Procedure Codes Q5108 and Q5110 Will Be Added to Colony Stimulating Factors Policy Effective July 1, 2019 Information posted May 17, 2019 Mogamulizumab-kpkc (Poteligeo) a Benefit of Texas Medicaid Effective March 1, 2019 Information posted May 23, 2019 Benefit Limitations for Epoetin Beta (Mircera) Information posted April 24, 2019 Removed procedure code Q4081 from the CAD handbook section 6.1.4, “Nonspecific, Unlisted or Miscellaneous Procedure Codes,” as the procedure code is housed in the Clinics handbook - Renal Dialysis section.
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook	Deactivated NCCI MUE Limitations for Substance Use Disorder Treatment and Breast Pump Replacement Parts Information posted May 31, 2019 Tobacco Use Cessation Services Provided in a Group Setting Information posted May 17, 2019
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Tobacco Use Cessation Services Provided in a Group Setting Information posted May 17, 2019
Radiology and Laboratory Services Handbook	Updated Limitation for Zika Virus Testing Effective July 1, 2019 Information posted May 17, 2019

June 2019 Release Notes
Handbook	Related Articles and Notes
Behavioral Health and Case Management Services Handbook	Removed procedure code H2035 in subsection 9.11.1, “Withdrawal Management Services” to align with policy. Removed language in subsection 9.11.2, “MAT Services” to align with policy.
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), Appendix B: Immunizations, and Appendix F: THSteps Quick Reference Guide	In section 5.3.11.3, “Immunizations” added missing word “second” to the vaccine administration statement that addresses administration with counseling and administration without counseling in order to align with policy statement in the Vaccine and Toxoid Administration medical policy. Article published "HPV2 and HPV4 No Longer Available Through TVFC Program" Information posted June 10, 2016
Clinician-Administered Drugs (CAD) Handbook	Update to ‘First Quarter 2019 HCPCS Updates for Texas Medicaid’ Information posted April 16, 2019
Inpatient and Outpatient Hospital Services Handbook	Updated language in subsection 3.6.1, “Admission Review.”
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Article published "HPV2 and HPV4 No Longer Available Through TVFC Program" Information posted June 10, 2016 In subsection 9.2.57.3.7, “Observation Services,” for clarity purposes removed “inpatient" - the procedure codes listed in the statement can be rendered in the inpatient and outpatient setting. Changes to the Sterilization Consent Form, Instructions, and Denial Letter Effective April 26, 2019 Information posted March 8, 2019

May 2019 Release notes
Handbook	Related Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities	Added note regarding additional physical address requirements in subsection 1.4.3, “Physical Address.” Updated language regarding EHR Incentive Program throughout Section 1.7
Volume 1: Section 6: Claims Filing	Added “NPI number of the referring and prescribing provider,” to the UB-04 instructions for blocks 78-79 in subsection, 6.6.3 “UB-04 CMS-1450 Instructions Table.”
Behavioral Health and Case Management Services Handbook	Added statement regarding automatic eligibility in subsection 5.2.3.2, “Eligibility and Service Determinations for Clients Who are 21 Years of Age and Older.” Added new section 4.6, “Court-Ordered Services.”
Clinician-Administered Drugs (CAD) Handbook	Updated Prior Authorization Requirements for Chimeric Antigen Receptor (CAR) T-cell Therapy Information posted March 29, 2019
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Added a note regarding handwritten alterations on invoices in subsection 2.2.2, “Durable Medical Equipment (DME) and Supplies.” Update to Maximum Limitations for Incontinence Procedure Codes A4396 and A4399 Information posted April 12, 2019
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook	Smoking and Tobacco Use Cessation Counseling Benefits to Change for Texas Medicaid on May 1, 2019 Information posted March 19, 2019
Inpatient and Outpatient Hospital Services Handbook	Revised language regarding court-ordered services throughout section 3.
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Smoking and Tobacco Use Cessation Counseling Benefits to Change for Texas Medicaid on May 1, 2019 Information posted March 19, 2019 Update to TMPPM for Cytopathology Studies and Therapeutic Apheresis Information posted April 26, 2019

April 2019 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities	Updated the Provider EVV Vendor Selection Form hyperlink in subsection 1.12, “Forms”.
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9), Appendix B: Immunizations, and : Appendix F: THSteps Quick Reference Guide	HPV2 and HPV4 No Longer Available Through TVFC Program Information posted June 10, 2016
Clinician-Administered Drugs (CAD) Handbook	Additional Payable Diagnosis Code for Procedure Code J1300 Eculizumab Information posted January 18, 2019 Updated Prior Authorization Requirements for Chimeric Antigen Receptor (CAR) T-cell Therapy Information posted March 29, 2019 Updated prior authorization statements to include text “all of,” within section 27, “Ibalizumab-uiyk (Trogarzo).” Updated prior authorization statements to include text “all of,” within section 40, “Patisiran (Onpattro).” April 2019 Second Quarter NCCI Updates for Texas Medicaid Information posted March 12, 2019
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	HPV2 and HPV4 No Longer Available Through TVFC Program Information posted June 10, 2016 Wound Care Procedure Codes Q4186 and Q4187 are Benefits Effective January 1, 2019 Information posted March 29, 2019
Vision and Hearing Services Handbook	Vision and Hearing Handbook Updated to Clarify Hearing Aid Invoice Requirements Information posted March 15, 2019
Women’s Health Services Handbook	HPV2 and HPV4 No Longer Available Through TVFC Program Information posted June 10, 2016

March 2019 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 6: Claims Filing	Added claims language to subsection 6.4.2.8, “Attachment to Claims.”
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9)	Added statement to section 2.2.2, “Documentation Requirements,” about the claims process involving MCO recoupments. Updated website link in section 3.6.1, “Cost Reporting,” with the following: https://rad.hhs.texas.gov/acute-care/school-health-and-related-services/shars-cost-report-information.
Clinician-Administered Drugs (CAD) Handbook	Effective March 1, 2019, New Prior Authorization Criteria for Patisiran Information posted February 1, 2019
Clinics and Other Outpatient Facility Services Handbook	Added clarifying statement to subsection 6.2.4, “Facility Revenue Codes,” to make it clear that renal dialysis facilities should not submit a HCPCS/CPT code on the claim with a revenue code.
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Removed procedure code A9275 from subsection 2.2.11.3, “Glucose Testing Equipment and Other Supplies.”
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook	Added “refer to” for breast pump chart in Section 3, “Breastfeeding Support Services.”
Medicaid Managed Care Handbook	Added claims language to subsection 2.7.3.2, “Documentation Requirements.” Update to Texas Medicaid Provider Procedures Manual, Medicaid Managed Care Services Information posted February 22, 2019
Telecommunication Services Handbook	Overview of Telemonitoring Benefit Changes for Texas Medicaid Information posted February 26, 2019
Women’s Health Services Handbook	Updated “HHSC Family Planning Program Services Policy and Procedure Manual” links throughout handbook. Updated HTW website link in subsection “HTW Provider Enrollment.”

February 2019 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 4: Client Eligibility	Replaced “yourtexasbenefitcard.com” with “TexMedConnect” throughout handbook.
Volume 1: Section 5: Fee-for-Service Prior Authorizations	Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 5.1.1 “Prior Authorization Requests for Clients with Retroactive Eligibility.”
Volume 1: Section 6: Claims Filing	Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 6.1.4 “Claims Filing Deadlines.”
Volume 1: Section 7: Appeals	Reminder: Beginning December 17, 2018, Providers Can Submit Administrative Appeals Electronically Information posted November 27, 2018
Volume 1: Section 8: Third Party Liability (TPL)	Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 8.2, “Verifying a Client’s TPR.”
Behavioral Health and Case Management Services Handbook	2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Information posted December 31, 2018 Update to add “or both” to section 6.2, “Peer Specialist Requirements.” Removed the “x” from the table in subsection 5.1.4.5, “Certifications for Mental Health Rehabilitative Services.” Added new SUD forms/links to section 12, “Forms.”
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) and THSteps Dental services (Section 4)	New Psychological Assessment Procedure Codes for SHARS Providers Effective January 1, 2019 Information posted December 21, 2018 HHSC to Decommission the YourTexasBenefitsCard.com Website on December 14, 2018 Information posted December 7, 2018 Update to Children’s Services Handbook to Remove Requirements about Timely Checkup Reports Information posted January 28, 2019 Update to Children’s Services Handbook Texas Health Steps Medical Checkups Information posted December 14, 2018 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Information posted December 31, 2018 Updated website link in section 3.6.1, “Cost Reporting,” with the following: https://rad.hhs.texas.gov/acute-care/school-health-and-related-services/shars-cost-report-information In section 4.2.16, “Periodontal Services,” under the Nonsurgical Periodontal Services section of the table, removed procedure codes D1110, D1120, D1206, D1208, D1351, D1510, and D1520 from the relationship statements for procedure codes D4341, D4342, and D4355 to align with statements 79-81 in the Texas Health Steps (THSteps) Therapeutic Dental Services medical policy.
Clinician-Administered Drugs (CAD) Handbook	2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Information posted December 31, 2018
Clinics and Other Outpatient Facility Services Handbook	2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Information posted December 31, 2018 Update to Benefit Limitation for Procedure Codes 96160 and 96161 in the Clinics and Other Outpatient Facility Services Handbook Information to be posted January 25, 2019 Added procedure code 96116, as this code is payable to FQHCs and the code was not listed in the table.
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Correction to the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook for CGM Devices Information posted December 14, 2018 2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Information posted December 31, 2018 Correction to Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook Information posted January 25, 2019
Medicaid Managed Care Handbook	Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 2.3.2, “Eligibility Verification Resources.”
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Information posted December 31, 2018
Radiology and Laboratory Services Handbook	2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Information posted December 31, 2018 Updated language in subsection 2.1.1, “Clinical Laboratory Improvement Amendments (CLIA).”
Vision and Hearing Services Handbook	2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Information posted December 31, 2018 Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 4.2, “Provider Responsibilities.”
Women’s Health Services Handbook	2019 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin Information posted December 31, 2018 Replaced “yourtexasbenefitcard.com” with “TexMedConnect” in subsection 2.1, “Guidelines for HTW Providers.”

January 2019 TMPPM Release Notes
Handbook	Related Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities	Added new provider type State Supported Living Center (SSLC) to subsection 1.1.4 “Provider Enrollment Identification.”
Volume 1: Section 6: Claims Filing	Updated claims filing deadline calendars/holiday calendar and links in subsection 6.1.4 “Claims Filing Deadlines,” and 6.1.6 “Filing Deadline Calendars.”
Volume 1: Appendix A: State, Federal, and TMHP Contact Information	Revised “abuse” as “use” in section A.10, “TMHP Telephone and Fax Communication.” Home Health Services Prior Authorization Requests No Longer Accepted Over the Phone Effective November 1, 2013 Information posted September 13, 2013
Volume 1: Appendix B: Vendor Drug Program	Revised language and grammar throughout the chapter.
Ambulance Services Handbook	Revised “abuse” as “use” in subsection 2.2.1, “Emergency Ambulance Transport Services.”
Behavioral Health and Case Management Services Handbook	Revised “abuse” as “use” in subsection 5.2.3.5.1, “Independent Living Services.” Peer Specialist Services to Become a Benefit of Texas Medicaid January 1, 2019 Information posted November 16, 2018 Revised “abuse” as “use” in section 7, “Screening, Brief Intervention, and Referral to Treatment (SBIRT).” Substance Use Disorder Benefits to Change for Texas Medicaid January 1, 2019 Information posted November 16, 2018
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) and THSteps Dental services (Section 4)	Revised “abuse” as “use” in subsection 5.3.11.1.3, “Mental Health Screening.” Portability Permits No Longer Required for Dentists with Anesthesia or Sedation Permits Effective January 1, 2019 Information posted November 16, 2018 Moved section 4.2.23, “Dental Therapy Under General Anesthesia” to the Mandatory Prior Authorization section to be combined with subsection 4.2.30.2, “General Anesthesia for Dental Treatment.” Added procedure codes D4341 and D4342 to Section 4.2.30, “Mandatory Prior Authorization.”
Clinician-Administered Drugs (CAD) Handbook	Third Quarter 2018 HCPCS Updates for Texas Medicaid Information posted September 28, 2018
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook	Procedure Code T4528 with Modifier U1 No Longer a Benefit January 1, 2019 Information posted November 16, 2018
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook	Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook Updated to Clarify Delivery Modifier Requirement Information posted December 14, 2018
Inpatient and Outpatient Hospital Services Handbook	Revised “abuse” as “use” in subsection 3.4.5, “Medicaid Clinical Criteria for Inpatient Psychiatric Care for Clients.”
Medicaid Managed Care Handbook	Added “STAR Kids” to section 1 “General Information.”
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook	Shingles Vaccine Procedure Code 90750 to Become a Benefit of Texas Medicaid January 1, 2019 Information posted November 16, 2018
Radiology and Laboratory Services Handbook	Revised “abuse” as “use” in subsection 3.2.6, “Authorization Requirements for CT, CTA, MRI, FMRI, MRA, PET, and Cardiac Nuclear Imaging Services.”
Vision and Hearing Services Handbook	Updated reimbursement rate for eyeglass frames in subsection 4.3.4 “No covered Services.”