Prior Authorization Updates for Neurostimulators and Neuromuscular Stimulators

Date: July 18, 2023

Attention: All Providers

Effective date: July 1, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a new prior authorization requirement effective July 1, 2023, for neurostimulators and transcutaneous electrical supply- CPT Code A4560.

How this impacts providers: This prior authorization requirement aligns with the TMPPM and applies to all lines of business CHIP, STAR, and STAR Kids. There is a limit to one unit every 12 weeks or four units per year.

Source: Texas Medicaid Provider Procedure Manual July 2023, sections 9.2.44.1, 9.2.44.2 - Prior Authorization for Neurostimulators and section 9.2.44.5,​* NMES and TENS Supplies

Next step for Providers: Providers should share this communication with their staff and follow the guidance outlined here. 

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.