Visit the VDP website for more information. lock This guide was designed for healthcare providers and other professionals who provide services, information, and support to young people (PDF). Please read a Special Notice from the HHSC to learn more about your role in stopping Medicaid fraud in the State of Texas. Billing Requirements. Therapy Fee Schedule effective 03/01/2022 update 06/16/2022 (xls) (pdf) Therapy Fee Schedule effective 07/01/2020 update 08/18/2020 (xls) Therapy Fee Schedule effective 01/01/2019 update 06/27/2019 (xls) Therapy Fee Schedule effective 01/01/2018 update The twelfth field lists the access-based fee amount or maximum fee. Procedure Code. Downloads The eleventh field lists the prospective payment system (PPS) fee. 2020, and this fee schedule was posted on the agency's If you think a dentist or another MCNA member is doing something that could be fraud, waste, or abuse please report it to the Office of the Inspector General (OIG). To request more information about MCNAs Cultural Competency Program and how it can help you provide culturally sensitive care to members, please call our Provider Hotline or send an email to qualityprogram@mcna.net. The eighth field lists the payable amount for the TOS and procedure code. Providers who perform only the technical service may be paid only for the technical component (TOS T). We recognize that the diversity of our member population can serve as a barrier to accessing dental services. . CMS issued a CY 2023 Medicare Physician Fee Schedule (PFS) final rule to expand access to behavioral health care, cancer screening coverage, and dental care. endstream endobj startxref Effective July 1, 2018, mental health screenings may be completed annually for all adolescents 12 through 18 years of age. MCNA Dental sends monthly newsletters to all of our providers, delivered right to their email inboxes! You can decide how often to receive updates. A Increase font size. 191 0 obj <>/Filter/FlateDecode/ID[<9221E417D63B4745B07D45277027F0AD><2F5A13B4B7FCA94D9FBABFD9A90D8FA1>]/Index[182 22]/Length 61/Prev 1295664/Root 183 0 R/Size 204/Type/XRef/W[1 2 1]>>stream This spending increase is attributable to greater telemedicine and telehealth service utilization among Medicaid clients. To stay up-to-date with all MCNA Dental news and announcements, you can periodically check our main news page on MCNA.net. A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. If calling after hours, please leave a message for our representatives. The comment period will close on December 31, 2019. As dentists, we recognize the dedication that Medicaid providers such as you have to the oral health of Texas children and adults. Heres how you know. SERVICES S8301 0 999 Years 0.00 $0.0000 $0.00 4/1/2020 $0.00 5 9/1/2021 1 MEDICAL SERVICES T1019 U3 0 20 Years 0.00 $0.0000 $2.75 9/1/2015 0.00 $2.75 9/1/2022 . .gov or E84;s03Hv0587m2pi&n>5{T! )k To use a general fee schedule, Medicaid providers can click Static Fee Schedules. https:// The IRS W-9 Form and Payment Method Selection Form . The Texas Health and Human Services Commission (HHSC) has identified a portion of CHIP members in the July 2021 renewal population that received incorrect information in their renewal packets, resulting in their coverage ending effective July 31, 2021. hVnIz}!aV 0!O}S]h`aX@ApDP XF/|p Udb^ag(~}zlohp LP`Xq9myV9|l}pxUb+q3Aw&)!VoGn^nZp`vRebs8g2{Rv*;01ili/$Wjb]j]ujUJiGks~l2mvXmrUgY[OPmOj}ofQ6fy1^`cvek`Q?,5 f[vpbdZJ] @${+5!8$Irm n*^6 YVJg{: We serve over 5 million children and adults with the singular mission of improving their general health by ensuring access to quality dental care. However, not all procedures require a modifier. An official website of the United States government %PDF-1.6 % %%EOF Sign up to get the latest information about your choice of CMS topics. Results may vary based on the claim type selected. TMHP publications and medical/dental policy documentation are available for searches Send a written complaint to: MCNA Dental The Provider Finance Department develops reimbursement methodology rules for determining payment rates or rate ceilings for recommendation to the Health and Human Services Commission for Medicaid payment rates and non-Medicaid payment rates for programs operated by the Department of State Health Services, the Department of Family and Protective Services and the Health and Human Services Commission. Child Age. TOS 4, 5 or 6 = Total Component (Technical + Interpretation). endstream endobj 348 0 obj <> endobj 349 0 obj <> endobj 350 0 obj <>stream It offers age-appropriate anticipatory guidance topics for children, birth through 20 years of age, and mirrors anticipatory guidance topics included on the THSteps Child Health Clinical Record Forms. The Texas Medicaid physician, advanced practice nurse (APN), and certified registered nurse anesthetists (CRNA) fee schedules each contain a list of payment rates for Current Procedural Terminology (CPT) codes, including the TOS 7 American Society of Anesthesiologists (ASA) procedure codes. Approved screening tools now include: Effective July 1, 2018, maternal postpartum depression screening may be completed and reimbursed once per provider, in the 12 months following the infant's birth during a Texas Health Steps checkup when the screening is completed using a validated screening tool. Click here for more information. https:// Jlu(S]%!sU$t~PK{ !vkZIJ8:gqf^/p|GlVT2Q!){1{ 9{Nd@*CCS|rVO~? MCNA encourages you to contact the Provider Hotline if would like to file an appeal with us. All rights reserved. MCNAs Dental Advisory Committee (DAC) is a nine-member group consisting of MCNA leadership and representatives of the Texas Dental Association (TDA), Texas Academy of Pediatric Dentists (TAPD), Texas Academy of General Dentists (TAGD), and the University of Texas Health Science Center School of Dentistry. 9 H0)#HfAA*HX @1H1|-kp,N2W>nvKqR@@%f;@(D-?IC `\ If a TOS I is paid first, then a TOS T may be payable. See CMS-1715-F in the "Related Links" section below. Procedure codes with a TOS 6 include radiation therapy services that are both the technical component and the interpretation (professional) component of radiology treatment planning, radiological dosimetry, teletherapy, megavoltage treatment and radioelement application services. The following resources will assist you in completing Texas Health Steps checkup documentation: Contact your Texas Health Steps regional provider relations representative (PDF) for help and support with documenting Texas Health Steps checkups. These tools were designed by THSteps to assist medical providers in incorporating other members of the team in completing THSteps Checkups. If you have exhausted MCNAs complaint process and are still not happy, you may submit a complaint directly to the HHSC using the following email address: HPM_Complaints@HHSC.state.tx.us. Effective January 1, 2020 through August 31, 2023, HHSC is paying an add-on to the direct care portion of the Supervised Living and Residential Support Services (SL/RSS) rates. Stay connected with all of the latest news and updates from MCNA through our Dental Details provider newsletter. Provider Manuals Last updated on 6/16/2020 Provider manuals are the providers' principal source of information about state health-care programs. hb```f``:"K@ (1=nYCp0p Your call will be returned on the next business day. Use the following information for processing bills for TOS 6 (Radiation Therapy), TOS T (Technical), and TOS I (Interpretation). Procedure codes with a type of service (TOS) 4 include radiology services that are both the technical component and the interpretation (professional) component of X-ray services. Medicaid Supplemental Payment & Directed Payment Programs, Oral Evaluation & Fluoride Varnish in the Medical Home, Download the LARGE version in Color (PDF), This guide was designed specifically for THSteps providers (PDF), THSteps on-line Anticipatory Guidance Provider Guide tool, This guide was designed for healthcare providers and other professionals who provide services, information, and support to young people (PDF), THSteps Checkup Whole Office Approach (Excel), Checkup Components Whole Office Approach (PDF), Texas Health Steps Documentation Improvement Provider Letter (PDF), Texas Health Steps Clinical Record Review Tool with Instructions (Excel), Texas Health Steps Clinical Record Review Tool (PDF), Contact your Texas Health Steps regional provider relations representative (PDF), Asthma-Guidelines for Diagnosis and Management, THSteps Medical Checkup Laboratory Requirements (PDF), DSHS Laboratory Checklist for THSteps Medical Providers (PDF), Texas Health Steps Risk Based Guidance Tool (PDF), Texas Administrative Code (TAC), Title 25 (Part 1), Chapter 37, Subchapter Q Rule 37.334, DSHS Blood Lead Surveillance Group's website, Visit Texas Childhood Lead Poisoning Prevention Program for electronic reporting, Pediatric Symptom Checklist for Youth (Y-PSC), Patient Health Questionnaire Modified for Adolescents (PHQ-A [depression screen]), Car, Relax, Alone, Forget, Family, and Trouble Checklist (CRAFFT), Patient Health Questionnaire (PHQ-A [anxiety, eating problems, mood problems and substance abuse]), Edinburgh Postnatal Depression Scale (EPDS), Postpartum Depression Screening Scale (PPDS). This file will also map Zip Codes to their State. 6 Radiation Therapy (total component, i.e., technical and interpretation) Includes radiology treatment planning, radiological dosimetry, teletherapy, megavoltage treatment and radioelement application. These rates are uniform statewide and by provider type. Secure .gov websites use HTTPSA Monitors the non-federal share funds of Medicaid payments that are provided by local governmental entities. The .gov means its official. 2 contacts listings. Therapy Fee Schedule for Home Health (Effective 9/1/17) (PDF) Therapy Fee Schedule for Individual Therapist Group (Effective 9/1/17) (PDF) If you have additional questions regarding these fee schedule changes, please contact Provider Services at 1-877-391-5921 or your Account Manager. website belongs to an official government organization in the United States. You can submit a Medicaid or CHIP complaint by calling our Provider Hotline at 1-855-776-6262or by sending an email to TX_PR_Dept@mcna.net. You can send an email to our Texas Provider Relations Department at, American Dental Associations (ADA) Credentialing Service, powered by CAQH ProView, Universal Texas Credentialing Application, Territory Assignments of Provider Relations Representatives and Contact Information, Add Existing Provider to Existing Location, Criteria for Dental Therapy Under General Anesthesia, Therapeutic Treatment with Anesthesia Prior Authorization Request Form, Texas Medicaid and Healthcare Partnership (TMHP), HHS Cultural Competency Educational Program, Pre-Authorization and Claims Submission Guide, U.S. Department of Health and Human Services Office of Minority Health website. In addition, this file contains an urban, rural or a low density (qualified) area Zip Code indicator. How can I learn more about culturally sensitive care? Your dental office may enroll in our Texas Medicaid and CHIP network by following the process below: Call the MCNA Provider Hotline at 1-855-776-6262 or email us at Provider_Enrollment@MCNA.net to tell us you would like to join the MCNA network. Where can I find information about MCNAs prior authorization process and requirements? Medicare Fee Schedules - Novitas . Fee Schedule. However, if you prefer to submit a paper application instead, you may download and complete theUniversal Texas Credentialing Applicationand submit it to MCNAvia one of the following methods: Please note there may be additional processing time if choosing to submit this paper application. Copyright 2016-2023. Key Details This guide was designed specifically for THSteps providers (PDF). The Pre-Authorization and Claims Submission Guide provides coverage criteria and prior authorization requirements in an easily searchable format. means youve safely connected to the .gov website. The CPT codes are divided into sections based on the type of service codes. See 4420, Type of Services Definition and Payment Information, below. MCNA is a current dental benefits administrator for Texas Medicaid and CHIP dental program. MCOs and dental plans are not required to foll ow the Texas Medicaid fee schedules, so there may be some differences in reimbursement based on decisions made by the individual health and dental plans. TOS 0 and TOS 9 are not basic health care services. For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) providers, including physicians, other practitioners and suppliers, go to the Provider Center (see under "Related Links" below). The confirmatory specimen may be sent to the DSHS Laboratory, or the client or specimen may be sent to a laboratory of the provider's choice. Under Labor Code 413.011(a), fee guidelines adopted by the Division of Workers' Compensation (DWC) for non-network services and approved out-of-network services are based on the most current reimbursement methodologies, models, and values or weights used by the federal Centers for . The Vendor Drug Program (VDP) provides statewide access to covered outpatient drugs for individuals enrolled in Medicaid, CHIP, the CSHCN Services program, the HTW program, and KHC program. .gov hbbd``b`j H ^WD X b``$( q Box 29008, San Antonio, TX 78229. Providers may access the most current fee schedules from the CMS link (s) below. If a TOS T is paid first, then a TOS I may be payable. Texas Health & Human Services Commission. Texas Medical Association 401 West 15th Street Austin TX 78701 . 0 Read the latest issue or consult our archive of past issues below. TOS 4, 5 or 6 = Total Component (Technical and Interpretation). ) p;Hv(1x`v3*}=W`:="9d=G#kLC@qp0 to high Providers who perform both the technical and the interpretation service may be paid for the total component (TOS 4). a primary procedure and secondary procedure(s). The payment standard for paying multiple surgical procedures that are not components of one comprehensive procedure is to allow the full HHSC physician payment standard for the primary procedure and half of the HHSC physician payment standard for the other procedure(s). cR!)?#m&fvNOfe>Z9uU]`Ga#]HE(B 9J>7hbPS:;V5=zVe!`R65=ntX9Xq^;o!Xvl?%VVKAY>Ih|>c8)LNlvSxs:{qOn?{B6o$Yhp gv:`qh7?l\cuHVd3Qnw5HbOpvL5VYR+,r]n7*}0OIpUdEZxx/ Please RSVP to reserve your seat at one of our upcoming sessions. Modifiers may affect the CIHCP payment amount. lock Not applicable for CIHCP. What can I do if I suspect Medicaid fraud in the State of Texas? endstream endobj startxref For a one-stop resource focused on new Care Management services under the Physician Fee Schedule, such as chronic care management and transitional care management services, visit the Care Management webpage. Some procedure codes might . A Decrease font size. lock See the press release, PFS fact sheet, Quality Payment Program fact sheets, and Medicare Shared Savings Program fact sheet for provisions effective January 1, 2023. I Interpretation Professional component for radiology, laboratory or radiation therapy services. The DAC meets on a quarterly basis to review benefit design, policies and procedures, and provider-related concerns. MCNA is contacting all affected members enrolled with us to encourage them to complete and submit the packet for coverage renewal as soon as possible. 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