Case Management for Children and Pregnant Women (CPW) COVID-19 Flexibilities

Date: February 1, 2023

Attention: All Providers

Providers 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: Texas Children’s Health Plan (TCHP) would like to make providers aware of direction from Texas Health and Human Services Commission (HHSC) regarding the Case Management for Children and Pregnant Women (CPW) program. In response to the COVID-19 public health emergency (PHE), HHSC has allowed CPW services, including comprehensive visits, to be completed by telephone (audio-only telecommunications) since April 1, 2020, and this flexibility will remain in place until HHSC provides further direction.

Effective September 1, 2022, CPW comprehensive visits and follow-up visits completed through the use of synchronous audiovisual technology is a benefit of Texas Medicaid.

How this impacts providers: Prior authorization and billing Guidance for CPW visits:

• When submitting a new prior authorization (CM-01) for a comprehensive visit to be completed using telephone (audio-only telecommunications), the provider must include “telephone comprehensive visit will be completed due to COVID-19” within the psychosocial section of the prior authorization request form.
• Modifier 93 must be included on the claim form when the comprehensive visit or follow-up visit is completed using telephone (audio-only) telecommunications

Next steps for providers: Providers should remain aware of HHSC communication on the CPG Program by regularly accessing TCHP’s thecheckup.org. or https://www.hhs.texas.gov/providers/health-services-providers/case-management-providers-children-pregnant-women.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.