New Rewards Coming Soon!¡Se vienen nuevas recompensas!
Our Healthy Rewards Program is getting an update in September! For a sneak peek of all the changes - including new rewards and ways to redeem them - please click here.
¡Nuestro Programa Healthy Rewards tendrá su actualización en septiembre! Para ver un adelanto de todos los cambios, incluyendo nuevas recompensas y formas de canjearlas, haz clic aquí.
Call to action: The purpose of this communication is to offer information about the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) prior authorization updates.
How this impacts providers: Effective January 1, 2024 Texas Children’s Health Plan’s (TCHP's) prior authorization updates are listed below. These changes follow guidance from Texas Medicaid and Healthcare Partnership (TMHP). Medical necessity criteria for utilization review will be in accordance with Texas Medicaid Provider Procedure Manual (TMPPM).
The following CPT codes REQUIRE prior authorization effective 1.1.2024:
J1304 (Toferson, inj, 1mg)
E0733 (Transcutaneous Nerve Stim-Trigeminal)
L5926 (Prosthesis-above knee)
The following CPT codes DO NOT REQUIRE prior authorization effective 1.1.2024: