Case Management for Children and Pregnant Women (CPW) - Medicaid Managed Care Carve-In
Date: 08/01/22
House Bill 133, 87th Legislature, Regular Session, 2021, requires the Case Management for Children and Pregnant Women (CPW) Program be carved-in to Medicaid managed care. CPW services are provided to help Medicaid eligible children and pregnant women to gain access to necessary medical, social, educational, and other services related to a member’s condition, health risk or high-risk condition. CPW Case Managers assess a person’s need for these services and then develop a service plan to address those needs.
For dates of service on or after September 1, 2022, Superior HealthPlan will be responsible for managing the delivery of CPW services to Superior Medicaid (STAR, STAR+PLUS, STAR Health, STAR Kids) and STAR+PLUS Medicare-Medicaid Plan (MMP) members.
Please Note: STAR Health members in conservatorship are excluded from this benefit.
Provider Enrollment
To be eligible for reimbursement for CPW, providers must be actively enrolled with Texas Medicaid through Texas Medicaid & Healthcare Partnership (TMHP) and contracted with Superior HealthPlan. To enroll in Texas Medicaid please visit the TMHP Provider Enrollment webpage. Providers may request to join Superior’s network by submitting their request at SuperiorHealthPlan.com/JoinOurNetwork.
Prior Authorization
Superior does not require prior authorization for CPW services at this time. Should Superior require prior authorization in the future, a notice will be posted 60 Days prior to the implementation date for the prior authorization requirement.
Coding and Claims Submission
Procedure code G9012 is to be used for all CPW services. Modifiers are used to identify which service component is provided. Please refer to the table below for coding requirements:
Service | Coding Requirements |
|---|---|
Comprehensive Visit (in person) | G9012 with modifiers U2 and U5 |
Comprehensive Visit (synchronous audiovisual) | G9012 with modifiers U2, U5 and 95 |
Follow-up Visit (in person) | G9012 with modifiers U5 and TS |
Follow-up Visit (synchronous audiovisual) | G9012 with modifiers U5, TS and 95 |
Follow-up Visit telephone(audio-only) | G9012 with modifiers TS and 93 |
Reminder: Billable services are defined in program rule 25 TAC §27.11.
CPW services are limited to one CPW visit per day, per member. Additional visits on the same day from any provider will be denied as part of another service rendered on the same day. In addition, CPW services are not billable when a person is admitted to an inpatient hospital or other treatment facility.
For information on submitting claims to Superior, please refer to Superior’s provider manuals at SuperiorHealthPlan.com/ProviderManuals.
For questions, please contact your local Account Manager.