Texas Medicaid Provider Procedures Manual July 2021 Provider Handbooks Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 JULY 2021 DURABLE MEDICAL EQUIPMENT, MEDICAL SUPPLIES, AND NUTRITIONAL PRODUCTS Table of Contents 1 General Information . 9 1.1 Payment Window Reimbursement Guidelines for Services Preceding an Inpatient Admission. 9 2 Texas Medicaid (Title XIX) Home Health Services . .10 2.1 Enrollment . .10 2.1.1 Pending Agency Certification . 10 2.1.2 Surety Bond Requirements. 11 2.1.2.1 Proof of Continuation. 11 2.2 Services, Benefits, Limitations and Prior Authorization . .12 2.2.1 Home Health Services . 12 2.2.1.1 Client Eligibility. 12 2.2.1.2 Prior Authorization Requests for Clients with Retroactive Eligibility . 13 2.2.1.3 Prior Authorization . 13 2.2.2 Durable Medical Equipment (DME) and Supplies . 14 2.2.2.1 Modifications, Adjustments, and Repairs . 17 2.2.2.1.1 Accessories . 18 2.2.2.2 Prior Authorization . 18 2.2.3 Home Health DME and Supplies Exceptional Circumstances Provision. 19 2.2.3.1 Prior Authorization Requests for Home Health DME and Supplies under the Exceptional Circumstances Provision. 19 2.2.3.2 Reimbursement and Billing . 20 2.2.4 Medical Supplies . 20 2.2.4.1 Supply Procedure Codes . 22 2.2.4.2 Prior Authorization . 22 2.2.4.3 Cancelling a Prior Authorization. 22 2.2.5 Augmentative Communication Device (ACD) System . 22 2.2.5.1 ACD System Accessories . 24 2.2.5.1.1 Carrying Case. 24 2.2.5.1.2 Nonwarranty Repairs . 24 2.2.5.1.3 Trial Period . 25 2.2.5.1.4 Rental . 25 2.2.5.1.5 Purchase . 25 2.2.5.1.6 Replacement . 25 2.2.5.1.7 Software. 25 2.2.5.2 Non-Covered ACD System Items . 26 2.2.5.3 Prior Authorization . 26 2.2.6 Bath and Bathroom Equipment . 28 2.2.6.1 Hand-Held Shower Wand . 28 2.2.6.2 Bath Equipment . 28 2.2.6.2.1 Bath or Shower Chairs, Tub Stool or Bench, Tub Transfer Bench . 28 2.2.6.3 Bathroom Equipment. 29 2.2.6.3.1 Non-fixed Toilet Rail, Bathtub Rail Attachment, and Raised Toilet 2 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED. DURABLE MEDICAL EQUIPMENT, MEDICAL SUPPLIES, AND NUTRITIONAL PRODUCTS HANDBOOK JULY 2021 Seat . 29 2.2.6.3.2 Toilet Seat Lifts. 30 2.2.6.3.3 Commode Chairs and Foot Rests . 30 2.2.6.3.4 Portable Sitz Bath. 32 2.2.6.3.5 Bath Lifts . 32 2.2.6.4 Prior Authorization . 34 2.2.6.5 Documentation Requirements . 34 2.2.6.5.1 Bath and Bathroom Equipment . 34 2.2.6.5.2 Toilet Seat Lifts. 34 2.2.7 Blood Pressure Devices (Manual and Automated). 35 2.2.7.1 Prior Authorization . 35 2.2.7.2 Hospital-Grade Blood Pressure Devices. 36 2.2.7.3 Components, Replacements, and Repairs. 37 2.2.7.4 Prior Authorization . 37 2.2.7.4.1 Components, Replacements, and Repairs . 38 2.2.8 Bone Growth Stimulators . 38 2.2.8.1 Professional Services. 39 2.2.8.2 Prior Authorization Criteria and Documentation Requirements for Bone Growth Stimulators . 39 2.2.8.2.1 Documentation for Noninvasive Electrical Bone Growth Stimulator. 39 2.2.8.2.2 Documentation for Invasive Electrical Bone Growth Stimulators . 40 2.2.8.2.3 Documentation for Ultrasound Bone Growth Stimulator . 40 2.2.8.3 Claims Reimbursement for Professional Services. 41 2.2.9 Breast Feeding Support Services . 41 2.2.10 Cochlear Implants . 41 2.2.11 Continuous Passive Motion (CPM) Device . 41 2.2.11.1 Prior Authorization . 41 2.2.12 Diabetic Equipment and Supplies . 41 2.2.12.1 Obtaining Equipment and Supplies Through a Title XIX Form . 42 2.2.12.2 Obtaining Equipment and Supplies Through a Verbal or Detailed Written Order. ..