Texas Medicaid Modifiers-Does anyone have

[Denise0728]

Does anyone have links or research sources they could share regarding Tx Medicaid modifiers and any guidelines for assignment/coding.

Medicaid is a new entity for me; so any resources would be greatly appreciated.

Thank you

 

[lauriepaul1115]

Texas Medicaid

http://www.tmhp.com/TMPPM/2011/Vol1_06_Claims_Filing.pdf

Go to section 6.3.5 Modifiers. It lists the modifiers and any special instructions.

hope this helps

LM

 

[btadlock1]

There's also this:
http://www.tmhp.com/HTMLmanuals/TMPPM/2008/2008 TMPPM-07-039.html

What I can tell you about them, is that TMHP is weird about modifiers. For example, we bill testing for both A & B strains of influenza; CPT guidelines, and every other payer in the world, instruct us to bill it as :
87804
87804-59

But TMHP wants it as:
87804
87804-91

Go figure.

Your best bet is to try to find modifier policies specific to the services you're trying to bill, to figure out what they want you to do. I suggest using a regular search engine to find it (Just type "TMHP coverage..." then your CPT codes and see what you come up with.) It's actually easier to find things that way, than to try to search for them on TMHP's website.

Once again, go figure. Good luck!

 

[Denise0728]

Thank you

Some light reading for the weekend

Thank you so much for a great start to research....