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