Case Management Changes from Local Codes to National Codes

Case Management for Children and Pregnant Women

Because of changes required by HIPAA (Health Insurance Portability and Accountability Act of 1996), effective October 16, 2003, Medicaid claims for case management services will no longer use local codes. Because there are not national codes for each billable component of Case Management for Children and Pregnant Women (CPW) a combination of procedure code and modifiers will be used. The current procedure codes will be not be accepted for dates of service on or after October 16, 2003. Following is a chart to show the new procedure code and modifiers for CPW claims for dates of service beginning October 16, 2003. Changes are being made to TDH Connect and NHIC systems to accommodate these changes. Any provider that is using a payment vendor will need to check to see if changes will need to be made with their method of filing electronic claims.