Update: Prior Authorization Requirements

Please note the following key prior authorization requirement changes for providers. Updates: Effective July 1, 2019

• Psychological testing (procedure codes 96130, 96131, 96136, and 96137), neurobehavioral testing (procedure codes 96116 and 96121), and neuropsychological testing (procedure codes 96132, 96133, 96136, and 96137) are limited to four hours per member, per day and eight hours per member, per calendar year. Prior Authorization will not be required when billed within these limits. Additional hours require prior authorization.
• Botulinum toxin injections will only require authorization when billed outside of the guidance of the Texas Medicaid Provider Procedure Manual Clinician Administered Drugs Handbook.

  Effective November 7, 2019 – Texas Children’s Health Plan will be updating the prior authorization listing. New to the list:

• Clinician Administered Drugs

C9045 - Injection, moxetumomab pasudotox-tdfk, 0.01 mg C9049 - Injection, tagraxofusp-erzs, 10 mcg C9050 - Injection, emapalumab-lzsg, 1 mg

• Mobility Aids

E0639 - Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories E0640 - Patient lift, fixed System, includes all components/accessories   The new Texas Children’s Health Plan prior authorization list will also be posted on texaschildrenshealth.org/for-providers. You can find it under the Provider Resources section. If there are further questions, please contact the Provider Network Management Department a t1- 800-731-8527.