Date: October 27, 2025
Attention: Providers
Subject: Update: Private Duty Nursing Authorization Clarification
Effective for dates of service on or after November 1, 2025
Call to action: Texas Children’s Health Plan (TCHP) would like to provide clarification on provider requirements for new and existing authorizations for Private Duty Nursing (PDN) services where submission of modifier UA is needed for claim reimbursement.
TCHP is aligned with HHSC Medicaid policy which requires prior authorization of private duty nursing services (T1000) and the modifier UA for specialized services when care is provided for members with a tracheostomy or who are ventilator dependent, effective November 1, 2025.
Existing Authorizations approved prior to November 1, 2025:
TCHP does not require modification of existing prior authorizations for PDN submitted without the modifier UA, including when the approved service end date spans past November 1, 2025.
New Requests submitted on or after November 1, 2025:
Prior authorization requests submitted on or after November 1, 2025 for PDN with specialized services will require authorization of the modifier UA. Providers should include the modifier UA and an appropriate diagnosis on the prior authorization form. Providers should also submit supporting clinical documentation.
Additional resources:
Next step for providers: Providers are advised to 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.
