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Case Management for Children and Pregnant Women

Overview

Information regarding Case Management for Children and Pregnant Women can be found on the Texas Department of State Health Services (DSHS) website.

Contacts

Note: Rate Analysis staff can assist you with questions concerning only payment rates for the case management services for children and pregnant women.

If you need case management services for children and/or (high risk) pregnant women, please call (877) 847-8377 or (877) THSTEPS.

If you have questions regarding Case Management for Children and Pregnant Women program/policy issues, please call DSHS at (512) 776-2168.

If you have questions regarding Case Management for Children and Pregnant Women payment rates, please call the Rate Analyst at the number on the Contacts List.

If you have questions regarding Case Management for Children and Pregnant Women billing issues, please call the TMHP Contact Center at the number on the Contacts List.

 

Methodology / Rules

Reimbursement rules applicable to Case Management for Children and Pregnant Women Services are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 21, Rule 8401.

Program Rules for Case Management for Children and Pregnant Women Services are located at Title 25 of the Texas Administrative Code, Part 1, Chapter 27, Rules 1, 3, 5, 7, 9, 11, 13, & 15

Payment Rate Information

Payment rate information is published by procedure code in the applicable Texas Medicaid Fee Schedule located on the Texas Medicaid & Healthcare Partnership (TMHP) website (see Fee Schedules).

Service
Maximum Rate
Limitations
Effective Date
Case Management - Comprehensive Visit Face to Face
$146.16
One contact/day
01/01/2013
Case Management - Follow up
Face to Face Visit
$122.31
One contact/day
01/01/2013
Case Management - Follow up Telephone contact
$29.36
One contact/day
01/01/2013
Case management - Comprehensive Visit Face to Face
$115.46
One contact/day
09/01/2011
Case Management - Follow up
Face to Face Visit
$57.73
One contact/day
09/01/2011
Case Management - Follow up Telephone contact
$21.65
One contact/day
09/01/2011

The fee schedules and any periodic adjustment(s) to the fee schedules are published in banner messages contained in provider Remittance and Status (R&S) reports, Medicaid Bulletin articles, web postings, provider manual, fee schedules or other provider notification.

Contact Rate Analysis

Send email to Rate Analysis


Updated: May 13, 2013