Update to the Durable Medical Equipment and Supplies Handbook

Date: November 4, 2021 Attention: Durable Medical Equipment, Primary Care, and Gastroenterologist Providers Effective Date: November 1, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.Call to action: On November 1, 2021, Texas Medicaid Health Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment and Supplies Handbook, subsection 2.2.18.1, “Enteral Nutritional Products, Feeding Pumps, and Feeding Supplies,” to clarify coverage for procedure code B9998. Texas Children’s Health Plan will align with this update from TMHP. How this impacts providers: Changes include the following:

• Procedure code B9998 may be reimbursed as needed without a modifier or with modifiers U1-U5 and limitations.
• A backpack or carrying case for a portable enteral nutrition infusion pump may be a benefit of Home Health Services when medically necessary and prior authorized, using procedure code B9998.

Next steps for providers: Providers should share this update with their staff. 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.