MEDICAL AND NURSING SPECIALISTS, PHYSICIANS, AND PHYSICIAN ASSISTANTS HANDBOOK TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 JUNE 2021 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 JUNE 2021 MEDICAL AND NURSING SPECIALISTS, PHYSICIANS, AND PHYSICIAN ASSISTANTS Table of Contents 1 General Information . 12 1.1 Payment Window Reimbursement Guidelines for Services Preceding an Inpatient Admission. .12 2 Chiropractic Manipulative Treatment (CMT) . .13 2.1 Enrollment . .13 2.2 Services, Benefits, Limitations, and Prior Authorization. .13 2.2.1 Prior Authorization . 14 2.3 Documentation Requirements . .14 2.4 Claims Filing and Reimbursement . .14 2.4.1 Claims Information . 14 2.4.2 Reimbursement . 14 3 Certified Nurse Midwife (CNM) . .15 3.1 Provider Enrollment. .15 3.1.1 Enrollment in Texas Health Steps (THSteps) . 16 3.2 Services, Benefits, Limitations, and Prior Authorization. .16 3.2.1 Deliveries . 16 3.2.2 Newborn Services . 16 3.2.3 Prenatal and Postpartum Services. 16 3.2.4 Laboratory and Radiology Services . 16 3.2.5 Prior Authorization . 16 3.2.6 Documentation Requirements . 17 3.2.7 Claims Filing and Reimbursement. 17 4 Certified Registered Nurse Anesthetist (CRNA) . .18 4.1 Enrollment . .18 4.2 Services, Benefits, Limitations, and Prior Authorization. .18 4.2.1 Prior Authorization . 19 4.3 Documentation Requirements . .19 4.4 Claims Filing and Reimbursement . .19 4.4.1 Claims Information . 19 4.4.1.1 Interpreting the R&S Report. 19 4.4.2 Reimbursement . 19 5 Geneticists . .20 5.1 Enrollment . .20 5.1.1 Geneticists . 20 5.2 Services, Benefits, Limitations, and Prior Authorization. .21 5.2.1 Family History . 21 5.2.2 Genetic Tests . 21 5.2.3 Laboratory Practices . 22 2 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED. MEDICAL AND NURSING SPECIALISTS, PHYSICIANS, AND PHYSICIAN ASSISTANTS HANDBOOK JUNE 2021 5.2.4 Genetic Counselors . 22 5.2.5 Genetic Evaluation and Counseling by a Geneticist . 22 5.2.6 Prior Authorization . 23 5.3 Documentation Requirements . .23 5.4 Claims Filing and Reimbursement . .23 5.4.1 Claims Information . 23 5.4.2 Reimbursement . 23 6 Licensed Midwife (LM). .24 6.1 Provider Enrollment. .24 6.2 Services, Benefits, Limitations, and Prior Authorization. .24 6.2.1 Deliveries . 24 6.2.2 Newborn Services . 24 6.2.3 Prenatal Services . 24 6.2.4 Prior Authorization . 25 6.2.5 Documentation Requirements . 25 6.2.6 Claims Filing and Reimbursement. 25 7 Maternity Service Clinics (MSC) . .25 7.1 Provider Enrollment. .25 7.1.1 Physician Responsibility . 26 7.1.2 Case Management Services to High-Risk Individuals . 26 7.2 Services, Benefits, Limitations, and Prior Authorization. .26 7.2.1 Initial Prenatal Care Visit Components. 27 7.2.1.1 History . ..