Clinics and Other Outpatient Facility Services Handbook - TMHP

TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 - JANUARY 2013
Enrollment as a Medicaid provider is not complete until the TMHP enrollment packet has been finalized
and a nine-digit provider identifier number is issued to the provider.
The effective date for participation is the date an approved provider application with the TB Services
Branch is established.
To receive a TB Services Branch provider application form or provider supplement, send a request to the
following address:
Refer to:
Texas Department of State Health Services
TB/HIV/STD/Viral Hepatitis Unit
Tuberculosis Services Branch
Mail Code 1939
1100 West 49th Street
PO Box 149347
Austin, TX 78714-9347
Subsection 1.1, “Provider Enrollment” in Section 1, “Provider Enrollment and Responsibilities”
(Vol. 1, General Information) for more information about enrollment procedures
related to the TMHP Medicaid enrollment applications.
8.1.1 Managed Care Program Enrollment
TB clinics do not need to enroll with the Medicaid managed care health plans. All services provided by
TB clinics are submitted to TMHP for all Medicaid clients, including Medicaid managed care clients.
8.2 Services, Benefits, Limitations, and Prior Authorization
The level of service provided varies depending on whether the services are delivered by a nonphysician
or physician and if medications are prescribed.
8.2.1 TB-Related Clinic Services
The following services may be performed by a physician, APRN, or PA in the TB clinic:
Procedure Codes
99201 99202 99203 99204 99205 99211 99212 99213 99214 99215
A physician’s presence is not required to perform procedure code 99211; however, the physician must
provide direct supervision by being present in the clinic and immediately available to furnish assistance
and direction at the time service is provided.
Before TB treatment can be initiated, an initial screening (procedure code T1023) by an RN, LPN, or
LVN, or a new patient physician E/M visit (procedure code 99201, 99202, 99203, 99204, or 99205) must
be performed. If the treatment is initiated by a nursing screening, a new patient physician E/M visit must
be completed within 90 days, or subsequent reimbursement for DOT (procedure code H0033) will be
denied.
Following the initial new patient physician E/M visit, an established patient physician E/M visit
(procedure code 99212, 99213, 99214, or 99215) must be billed every 90 days throughout the course of
treatment, or subsequent reimbursement for DOT (procedure code H0033) will be denied.
Clients with latent TB infection, including those in a high-risk group (children who are 4 years of age
and younger, those who are immunocompromised, and clients who are HIV-positive), and those with
active TB disease, must be seen by a physician every 90 days throughout the course of treatment.
A physician must evaluate each client with active or latent TB disease prior to discharge from TB
treatment.
Procedure codes H0033, T1002, T1003, and T1023 may be provided under established clinic protocols.
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