Date: June 9, 2025
Attention: Providers
Effective date: April 1, 2025
Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that effective April 1, 2025; dual-function home ventilators are available for rental with a limit of one per month.
New benefit added to Texas Medicaid:
- Procedure code E0468 - home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions.
- Clients, all ages, must meet medical necessity criteria for both a mechanical ventilator and a cough augmentation device.
How this impacts providers: Effective July 1, 2025, the updated benefit will be published in the Texas Medicaid Provider Procedures Manual (TMPPM) to include the following procedure codes that are considered bundled in the rental for the dual-function ventilator:
A4216, A4217, A4481, A4483, A4611, A4612, A4613, A4618, A7027, A7028, A7029, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7046, E0465, E0466, E0470, E0471, E0472, E0482, E0561, E0562, and E0601.
Next step for Providers: Providers should share this communication with their staff.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.
