Clinics and Other Outpatient Facility Services Handbook - TMHP
Clinics and Other Outpatient Facility Services Handbook - TMHP
Clinics and Other Outpatient Facility Services Handbook - TMHP
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TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 - JANUARY 2013<br />
Copayments<br />
CP001 CP002 CP003 CP004 CP005 CP006 CP007 CP008<br />
Refer to: Subsection 6.3.5, “Modifiers” in Section 6, “Claims Filing” (Vol. 1, General Information) for<br />
a definition of modifiers.<br />
Section 4, “Texas Health Steps (THSteps) Dental,” <strong>and</strong> Section 5, “THSteps Medical,” in<br />
the Children’s <strong>Services</strong> H<strong>and</strong>book (Vol. 2, Provider H<strong>and</strong>books).<br />
Section 3, “Texas Women’s Health Program,” <strong>and</strong> Section 4, “Department of State Health<br />
<strong>Services</strong> (DSHS) Family Planning Program <strong>Services</strong>,” in the Gynecological <strong>and</strong> Reproductive<br />
Health <strong>and</strong> Family Planning <strong>Services</strong> H<strong>and</strong>book (Vol. 2, Provider H<strong>and</strong>books).<br />
Section 4, “Vision Care Professionals,” in the Vision <strong>and</strong> Hearing <strong>Services</strong> H<strong>and</strong>book<br />
(Vol. 2, Provider H<strong>and</strong>books).<br />
Section 4, “Licensed Clinical Social Worker (LCSW), Licensed Marriage <strong>and</strong> Family<br />
Therapist (LMFT), <strong>and</strong> Licensed Professional Counselor (LPC),” in the Behavioral Health,<br />
Rehabilitation, <strong>and</strong> Case Management <strong>Services</strong> H<strong>and</strong>book (Vol. 2, Provider H<strong>and</strong>books).<br />
Subsection 8.2.60.1.2, “Preventive Care Visits” in the Medical <strong>and</strong> Nursing Specialists,<br />
Physicians, <strong>and</strong> Physician Assistants H<strong>and</strong>book (Vol. 2, Provider H<strong>and</strong>books).<br />
Section 6, “Physician, Psychologist, <strong>and</strong> Licensed Psychological Associate (LPA)<br />
Providers,” in the Behavioral Health, Rehabilitation, <strong>and</strong> Case Management <strong>Services</strong><br />
H<strong>and</strong>book (Vol. 2, Provider H<strong>and</strong>books).<br />
Subsection 6.12.2.2, “Health Maintenance Organization (HMO) Copayments” in Section 6,<br />
“Claims Filing” (Vol. 1, General Information).<br />
Medicaid coverage is limited to FQHC services that are covered by Texas Medicaid <strong>and</strong> are reasonable<br />
<strong>and</strong> medically necessary. When furnished to a client of the FQHC, medically necessary services include<br />
the following:<br />
• CNM services<br />
• Clinical psychologist services<br />
• Clinical social worker services; other mental health services<br />
• Dental services<br />
• NP services<br />
• <strong>Other</strong> ambulatory services included in Medicaid such as family planning, THSteps, <strong>and</strong> maternity<br />
service clinic (MSC)<br />
• PA services<br />
• Physician services<br />
• <strong>Services</strong> <strong>and</strong> supplies necessary for services that would be covered otherwise, if furnished by a<br />
physician or a physician service<br />
• Vision care services<br />
• Visiting nurse services to a homebound individual, in the case of those FQHCs located in areas with<br />
a shortage of home health agencies<br />
Types of FQHC visits are defined in 1 TAC §355.8261. A visit is a face-to-face encounter between an<br />
FQHC client <strong>and</strong> a physician, PA, NP, CNM, visiting nurse, qualified clinical psychologist, clinical social<br />
worker, other health-care professional for mental health services, dentist, dental hygienist, or optome-<br />
OP-14<br />
CPT ONLY - COPYRIGHT 2012 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.