2 DME and Supplies

1 Texas Medicaid Provider Procedures Manual January 2022. Provider Handbooks Durable Medical Equipment, Medical Supplies , and Nutritional Products Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 JANUARY 2022. DURABLE MEDICAL EQUIPMENT, MEDICAL. Supplies , AND NUTRITIONAL PRODUCTS. Table of Contents 1 General Information .. 9. Payment Window Reimbursement Guidelines for Services Preceding an Inpatient Admission.. 9. 2 Texas Medicaid (Title XIX) Home Health Services.

2 10. Enrollment ..10. Pending Agency Certification .. 10. Surety Bond Requirements.. 11. Proof of Continuation.. 11. Services, Benefits, Limitations and Prior Authorization ..12. Home Health Services .. 12. Client Eligibility .. 12. Prior Authorization Requests for Clients with Retroactive Eligibility .. 13. Prior Authorization .. 13. Durable Medical Equipment (DME) and Supplies .. 14. Modifications, Adjustments, and Repairs .. 17. Accessories .. 18. Prior Authorization .. 18. Home Health DME and Supplies Exceptional Circumstances Provision.. 19. Prior Authorization Requests for Home Health DME and Supplies under the Exceptional Circumstances Provision.

3 19. Reimbursement and Billing .. 20. Medical Supplies .. 20. Supply Procedure Codes .. 22. Prior Authorization .. 22. Cancelling a Prior Authorization.. 22. Augmentative Communication Device (ACD) System .. 22. ACD System Accessories .. 24. Carrying Case.. 24. Nonwarranty Repairs .. 24. Trial Period .. 25. Rental .. 25. Purchase .. 25. Replacement .. 25. Software.. 25. Non-Covered ACD System Items .. 26. Prior Authorization .. 26. Bath and Bathroom Equipment .. 28. Hand-Held Shower Wand .. 28. Bath Equipment .. 28. Bath or Shower Chairs, Tub Stool or Bench, Tub Transfer Bench .. 28. Bathroom Equipment.. 29. Non-fixed Toilet Rail, Bathtub Rail Attachment, and Raised Toilet 2.

4 CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED. DURABLE MEDICAL EQUIPMENT, MEDICAL Supplies , AND NUTRITIONAL PRODUCTS HANDBOOK JANUARY 2022. Seat .. 29. Toilet Seat Lifts.. 30. Commode Chairs and Foot Rests .. 30. Portable Sitz Bath .. 32. Bath Lifts .. 32. Prior Authorization .. 34. Documentation Requirements .. 34. Bath and Bathroom Equipment .. 34. Toilet Seat Lifts.. 34. Blood Pressure Devices (Manual and Automated).. 35. Prior Authorization .. 35. Hospital-Grade Blood Pressure Devices .. 36. Components, Replacements, and Repairs.. 37. Prior Authorization .. 37. Components, Replacements, and Repairs .. 38.

5 Bone Growth Stimulators .. 38. Professional Services.. 39. Prior Authorization Criteria and Documentation Requirements for Bone Growth Stimulators .. 39. Documentation for Noninvasive Electrical Bone Growth Stimulator.. 39. Documentation for Invasive Electrical Bone Growth Stimulators .. 40. Documentation for Ultrasound Bone Growth Stimulator .. 40. Claims Reimbursement for Professional Services .. 41. Breast Feeding Support Services .. 41. Cochlear Implants .. 41. Continuous Passive Motion (CPM) Device .. 41. Prior Authorization .. 41. Diabetic Equipment and Supplies .. 41. Obtaining Equipment and Supplies Through a Title XIX Form .. 42.

6 Obtaining Equipment and Supplies Through a Verbal or Detailed Written Order.. 42. Glucose Testing Equipment and Other Supplies .. 43. Prior Authorization .. 45. Blood Glucose Monitors.. 46. Prior Authorization .. 46. *Continuous Glucose Monitoring .. 46. Prior Authorization .. 47. Claims Filing Requirements .. 48. Non Covered Services .. 48. External Insulin Pump and Supplies .. 48. Prior Authorization .. 49. CGM Integrated Insulin Pump System .. 50. Prior Authorization .. 51. Insulin and Insulin Syringes .. 51. Donor Human Milk .. 51. Prior Authorization and Documentation Requirements .. 51. Donor Human Milk Services for Inpatient Clients.

7 52. Hospital Beds and Equipment.. 53. Hospital Beds.. 53. Pediatric Hospital Bed .. 54. Prior Authorization .. 55. 3. CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED. DURABLE MEDICAL EQUIPMENT, MEDICAL Supplies , AND NUTRITIONAL PRODUCTS HANDBOOK JANUARY 2022. Fixed-Height Hospital Bed.. 55. Variable-Height Hospital Bed .. 55. Semi-Electric Hospital Bed .. 56. Fully-Electric Hospital Bed.. 56. Pediatric Hospital Beds and Safety Enclosure .. 56. Documentation Requirements .. 57. Mattresses and Support Surfaces .. 57. Documentation Requirements .. 58. Group 1 Support Surfaces .. 58. Group 2 Support Surfaces .. 59.

8 Group 3 Support Surfaces .. 61. Equipment and Other Accessories.. 61. Accessories .. 62. Prior Authorization .. 62. Decubitus Care Accessories .. 62. Replacement .. 62. Prior Authorization .. 62. Non-covered Items .. 63. Hospital Beds and Equipment Procedure Code Table .. 63. Incontinence Supplies .. 64. Skin Sealants, Protectants, Moisturizers, and Ointments for Incontinence-Associated Dermatitis .. 65. Diapers, Briefs, Pull-ons, and Liners .. 65. Diaper Wipes .. 66. Underpads .. 66. Ostomy Supplies .. 66. Indwelling or Intermittent Urine Collection Devices .. 67. Indwelling Catheters and Related Insertion Supplies .. 67. Intermittent Catheters and Related Insertion Supplies .

9 67. External Urinary Collection Devices.. 68. Urinals and Bed Pans .. 68. Prior Authorization .. 68. Documentation Requirements .. 69. Incontinence Procedure Codes with Limitations .. 69. Intravenous (IV) Therapy Equipment and Supplies .. 73. Prior Authorization .. 75. Documentation Requirements .. 76. Mobility Aids .. 77. Canes, Crutches, and Walkers .. 77. Wheeled Mobility Systems .. 77. Prior Authorization .. 78. Documentation Requirements .. 78. Manual Wheelchairs-Standard, Standard Hemi, and Standard Reclining .. 78. Prior Authorization .. 79. Manual Wheelchairs-Lightweight and High-Strength Lightweight.. 79. Prior Authorization.

10 80. Manual Wheelchairs-Heavy-Duty and Extra Heavy Duty .. 80. Prior Authorization .. 80. Wheeled Mobility Systems .. 80. Definitions and Responsibilities .. 81. Prior Authorization .. 83. 4. CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED. DURABLE MEDICAL EQUIPMENT, MEDICAL Supplies , AND NUTRITIONAL PRODUCTS HANDBOOK JANUARY 2022. Documentation Requirements .. 83. Manual Wheeled Mobility System - Tilt-in-Space .. 84. Prior Authorization .. 84. Manual Wheeled Mobility System- Pediatric Size.. 84. Manual Wheeled Mobility System -Custom (Includes Custom Ultra- Lightweight) .. 85. Prior Authorization .. 85. Seating Assessment for Manual and Power Custom Wheelchairs.