Cold and flu season Temporada de influenza y resfriados

ALERT: Stay healthy this cold and flu season! Learn more

ALERTA: ¡Mantente sano durante esta temporada de influenza y resfriados! Más información

New Website! ¡Nuevo sitio web!

ALERT: We have made the Texas Children’s Health Plan website even easier to use! Click here to learn more.

ALERTA: ¡Ahora el sitio web de Texas Children’s Health Plan es aún más sencillo de usar! Haz clic aquí para más información.

Enfamil shortage updates Escasez de Enfamil Reguline

ALERT: Shortage of Enfamil products until October 31, 2024. Learn more.

ALERTA: Escasez de productos de Enfamil hasta el 31 de octubre de 2024. Más información.

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HCPCS and CPT Code Prior authorization Update

Date: February 26, 2024

Attention: All Providers

Effective date: January 1, 2024

Call to action: The purpose of this communication is to offer information about the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) prior authorization updates.

Resource: https://www.tmhp.com/sites/default/files/file-library/resources/rate-and-code-updates/hcpcs-updates/2024-hcpcs-special-bulletin.pdf

How this impacts providers: Effective January 1, 2024 Texas Children’s Health Plan’s (TCHP's) prior authorization updates are listed below. These changes follow guidance from Texas Medicaid and Healthcare Partnership (TMHP). Medical necessity criteria for utilization review will be in accordance with Texas Medicaid Provider Procedure Manual (TMPPM).

The following CPT codes REQUIRE prior authorization effective 1.1.2024: 

  • J1304 (Toferson, inj, 1mg) 
  • E0733 (Transcutaneous Nerve Stim-Trigeminal) 
  • L5926 (Prosthesis-above knee) 

The following CPT codes DO NOT REQUIRE prior authorization effective 1.1.2024: 

  • 75590 (MRI-coronary FFR) 
  • 27278 (Arthrodesis, sacroiliac joint) 
  • L3161 (foot adductus positioning device, adjustable) 

Next step for Providers: Providers should follow the prior authorization guidelines as stated above and 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,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.