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Prior authorizations for hospital beds reminder and new codes added

Attention: All Providers

Effective date for new codes: August 26, 2020

Call to action: Texas Children’s Health Plan (TCHP) would like to remind you that the following hospital beds and accessories’ codes require prior authorization. This follows the guidance from the Texas Medicaid Provider Procedures Manual (TMPPM).  
CodeDescription
E 0184Dry pressure mattress
E0185Gel or gel-like pressure pad for mattress, standard mattress length
E0186Air pressure mattress
E0187Water pressure mattress
E0188Synthetic sheepskin pad
E0189Lamb’s wool sheepskin pad, any size
E0190Positioning cushion/pillow/wedge, any shape or size
E0193Powered air flotation bed (low air loss therapy)
E0194Air fluidized bed
E0196Gel pressure mattress
E0197Air pressure pad for mattress, standard mattress length and width E0198 Water pressure pad for mattress, standard mattress length
E0198Water pressure pad for mattress, standard mattress length and width
E0199Dry pressure pad for mattress, standard mattress length and width
E0271Mattress, innerspring- 1 purchase every 5 years
E0277Powered pressure-reducing air mattress, 1 per month
E0315Bed accessory: board, table, or support device, any type
E0372Powered air overlay for mattress, standard mattress length
E0373Non-powered advanced pressure reducing mattress
E0371Non-powered advanced pressure reducing overlay for mattress, standard mattress length and width
E0912Trapeze bar
E0940Trapeze bar, freestanding

New Codes that required a prior authorization effective August 26, 2020:

CodeDescription
E0250Hospital bed, fixed height, with any type side rails, with mattress- 1 purchase every 5 years; 1 per month rental
E0255Hospital bed, variable height, hi-lo, with any type side rails, with mattress - 1 purchase every 5 years; 1 per month rental
E0260Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress- 1 purchase every 5 years; 1 per month rental
E0265Hospital bed, total electric (head, foot, and height adjustment s), with any type side rails, with mattress- 1 purchase every 5 years; 1 per month rental
E0300Pediatric crib, hospital grade, fully enclosed, with or without top enclosure- 1 per month rental
E0316Safety enclosure frame/canopy for use with hospital bed, any type-1 per month rental
E0328Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress-1 per month rental
E0329Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring includes mattress-1 per month rental
Reference: TMPPM hospital beds and equipmentPrior authorization form How this impacts providers: Providers should seek approval prior to billing the previously listed codes for hospital beds.   Next steps for providers: Update their office staff of the new authorization requirements.   If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers