Texas Medicaid

Benefit Update for Early Childhood Intervention for Texas Medicaid Effective September 1, 2017

Information posted July 18, 2017

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers

should contact the client’s specific MCO for details.

Effective for dates of service on or after September 1, 2017, Early Childhood Intervention (ECI) Services Comprehensive Care Program (CCP) benefits will be updated for Texas Medicaid.

New Benefit Information

The Medicaid medical policy describes the scope of the ECI Medicaid benefit, which may differ from the Physical, Occupational, or Speech Therapy (PT/OT/ST) Medicaid benefit, as follows.

• Speech therapy (ST) treatment codes will now be billed per encounter.

o  Only one individual encounter-based speech therapy treatment procedure code is payable once per day per provider.

o  The rendering speech therapy provider should select the code that best reflects the totality of the session delivered.

• Physical therapy (PT)/occupational therapy (OT) procedure codes representing supervised modalities will be payable as untimed procedure codes and billed per encounter.
• PT, OT, and ST group treatment will be payable as untimed procedure codes and billed per encounter.
• A modifier to designate whether a therapy treatment was provided by a licensed therapist or a licensed assistant will be required on all claims for therapy treatment procedure codes.
• It will now be permissible to deliver targeted case management (TCM) in inpatient and outpatient hospital settings.
• Missed visits may be rescheduled within the Individualized Family Service Plan

(IFSP) authorization period with appropriate documentation.

For more information about Early Childhood Intervention for Texas Medicaid please download load PDF from Community First Health Plans