Home and Community-based Services (HCS) Program Billing Guidelines

Appendix VII
Billable Adaptive Aids

Revision 13-1; Effective January 1, 2014

  1. Abbreviations and Numbers
  2. The following abbreviations and numbers, as used in this attachment, have the following meanings:

    1. Licensed Professionals
      • (AU) – A person licensed as an audiologist in accordance with Chapter 401 of the Texas Occupations Code.
      • (DI) – A person licensed as a dietitian in accordance with Chapter 701 of the Texas Occupations Code.
      • (NU) – A person licensed to practice professional or vocational nursing by the Board of Nurse Examiners in accordance with Chapter 301 of the Texas Occupations Code.
      • (MD) – A person licensed as a physician in accordance with Texas Occupations Code, Chapter 155.
      • (OT) – A person licensed as an occupational therapist in accordance with Chapter 454 of the Texas Occupations Code.
      • (OPH) – A person licensed as a physician in accordance with Texas Occupations Code, Chapter 155, and certified by the American Board of Ophthalmology.
      • (OPT) – A person licensed as an optometrist or therapeutic optometrist in accordance with Texas Occupations Code, Chapter 351.
      • (PT) – A person licensed as a physical therapist in accordance with Chapter 453 of the Texas Occupations Code.
      • (PS/BS) – A person licensed as a psychologist, provisional license holder or psychological associate in accordance with Chapter 501 of the Texas Occupations Code; a person certified by DADS as described in 40 TAC §5.161; or a behavior analyst certified by the Behavior Analyst Certification Board, Inc.
      • (SP) – A person licensed as a speech-language pathologist in accordance with Chapter 401 of the Texas Occupations Code.
    2. Other Abbreviations and Numbers
      • (1) – The item is available through Texas Medicaid Home Health Services and Medicare for all individuals.
      • (2) – The item is available through Texas Health Steps for all individuals under the age of 21.
  3. List of Billable Adaptive Aids
  4. The following items and services, listed by category, including repair and maintenance not covered by warranty, are billable adaptive aids:

    • Lifts

    101

    a vehicle lift adaptation for a vehicle owned by an individual, an individualís family member or foster/companion care provider if it is the primary mode of transportation for the individual, but not to exceed one lift every five years. Repairs and maintenance not covered by warranty are not limited to the five-year requirement.

    • A vehicle that is expected to be modified or adapted must meet one of the following criteria:
      • vehicle is less than 5 years old and mileage is less than 50,000 miles; or
      • vehicle passed an independent inspection performed by a certified automotive technician.
    (OT, PT, MD)

    104

    a hydraulic, manual or electronic lift (1, 2) (OT, PT, MD), replacement sling (1) (OT, PT, MD), a barrier-free (ceiling or wall mounted) lift system, a porch lift or stair lift

    128

    a transfer bench (1, 2) (OT, PT, MD)

    • Mobility Aids

    106

    a crutch, walker or cane (1, 2) (OT, PT, MD)

    107

    an orthotic device, orthopedic shoes or a brace which is custom fabricated specifically for an individual (2) (OT, PT, MD)

    157

    a manual or electric wheelchair or a necessary accessory (1, 2) (OT, PT, MD)

    158

    a forearm platform attachment for a walker (1, 2) (OT, PT, MD)

    159

    a portable wheelchair ramp (1, 2) (OT, PT, MD)

    160

    a battery or charger for an electric wheelchair (1, 2) (OT, PT, MD, NU)

    161

    a gait trainer or gait belt (1, 2) (OT, PT, MD, NU)

    163

    a stroller, push-chair or travel seat (OT, PT, MD)

    • Positioning Devices

    151

    a hospital bed (1) or crib (2) (OT, PT, MD)

    154

    a standing board or frame, positioning chair, or wedge (1, 2) (OT, PT, MD)

    155

    a trapeze bar (1, 2) (OT, PT, MD)

    156

    a lift chair, but not the lift mechanism if it is reimbursable through Medicare (OT, PT, MD)

    162

    a bath or shower chair (1, 2) (OT, PT, MD, NU)

    164

    a toileting chair (1, 2) (OT, PT, MD, NU)

    165

    a portable bathtub rail (1, 2) (OT, PT, MD)

    • Controls and Switches

    109

    a sip and puff control (1, 2) (OT, PT)

    110

    an adaptive switch used to operate items necessary for daily functioning (OT, PT)

    • Environmental Control Units

    111

    an adaptive lock (OT, PT)

    112

    an electronic control unit or automatic door opener (OT, PT)

    114

    a voice, light, smoke or motion activated device (OT, PT,AU)

    • Medical Supplies

    120

    diapers, briefs, pull-ons, liners, diaper wipes, disposable underpads, reusable underpads (1,2) (MD, NU)

    121

    a multivitamin product with a prescription, a nutritional supplement listed in the Texas Medicaid Provider Procedures Manual (for example, Ensure, Boost, Glucerna) or Thick-It (2) (MD)

    122

    an enteral feeding formula and supplies (1, 2) (MD)

    201

    medically necessary supplies for tracheotomy care, decubitus care, ostomy care, respirator/ventilator care or catheterization (1, 2) (MD)

    206

    a glucose monitor or other supplies for an individualís use in self-monitoring (1, 2) (MD, NU)

    207

    an adapted medication dispenser or pill crusher (MD, NU)

    208

    an air humidifier, purifier or specialized air filter, or a medically necessary portable heating and/or cooling device to manage the symptoms of a seizure disorder, respiratory or cardiac condition, or inability to regulate body temperature (MD)

    209

    a muscle stimulator (OT, PT, MD)

    210

    temporary rental of a billable adaptive aid to allow for the repair, purchase or replacement of the adaptive aid (1, 2) (OT, PT, MD, NU)

    211

    a urinal (1, 2) (MD, NU)

    212

    a specialized thermometer (MD, NU)

    213

    a specialized scale (MD, NU, DI)

    214

    medical support hose (1) (MD, NU)

    215

    specialized clothing (for example, a weighted vest), a dressing aid or bib (OT, PT, MD, NU)

    216

    a specialized or treated mattress or mattress cover (2) (MD, NU)

    217

    an egg-crate, sheepskin or other medically necessary mattress pad (1, 2) (MD, NU)

    218

    a cleft palate feeder (1, 2) (MD, OT, PT, DI)

    219

    a blood pressure or pulse monitor for an individualís use in self-monitoring (1) (MD, NU)

    220

    prescription eyeglasses beyond Medicaid limit (2) (OPH, OPT)

    221

    non-sterile disposable gloves for individuals who require catheterization, have skin breakdown or require wound care, or have a documented disease that may be transmitted through urine or stool and the care of the individual is provided by a non-paid caregiver (1,2) (MD,NU)

    • Communication Aids (including batteries)

    124

    a direct selection, alphanumeric, scanning or encoding communicator (2) (SP)

    125

    a speech amplifier or augmentative communication device (1, 2) (SP)

    126

    sign language interpreter service for non-routine communications, such as IDT meetings, or medical/professional appointments (SP, AU, MD)

    251

    an emergency response system or service, monitoring device (MD, NU) or medical alert bracelet (MD, NU)

    254

    a communication board or book (2) (SP)

    255

    a closed-captioning device for an individual with a hearing impairment (AU)

    256

    a signature stamp for an individual with a visual or physical impairment, muscular weakness or limited range of motion (OPH, OT, PT)

    257

    a signature guide for an individual with a visual or physical impairment, muscular weakness or limited range of motion (OPH, OT, PT)

    258

    a personal computer or accessory necessary for the individual to communicate independently (SP)

    259

    specialized training for augmentative communication software, not to exceed $1,000 per individual, per IPC year (2) (SP)

    260

    a hearing aid (2) (AU) or battery (2) (AU, MD, NU)

    • Adapted Equipment for Activities of Daily Living

    324

    a lever door handle (OT, PT)

    401

    a device or item used to enable an individual to independently pick up or grasp an object (for example, a reacher) (OT, PT)

    402

    a device or item used to enable an object to be firmly positioned and secure (for example, a dycem mat) (OT, PT)

    403

    a device or item used to enable an individual to independently hold and sustain control of an object (for example, a hand strap) (OT, PT)

    404

    adapted dinnerware, an eating utensil or meal preparation device (OT, PT)

    405

    a specialized clock or wristwatch for an individual with a visual or hearing impairment (OT, PT)

    406

    an electric razor or electric toothbrush for an individual with a muscular weakness or limited range of motion who shaves self or brushes own teeth (OT, PT)

    407

    a speaker, large button or braille telephone for an individual who is verbal but cannot use a conventional telephone (OT, PT)

    408

    a microwave oven, if use of a conventional oven presents a safety hazard to the individual (OT, PT)

    409

    a hand-held shower device (1, 2) (OT, PT)

    • Safety Restraints and Safety Devices

    113

    a safety restraint (2) (PS, MD) or wheelchair tie down (OT, PT, MD, NU)

    450

    a bed rail (1, 2) (OT, PT, MD, NU)

    451

    safety padding (1, 2) (PS/BS, OT, PT, MD)

    452

    a helmet used due to a seizure disorder or other medical condition (2) (PS/BS, MD, NU)

    453

    an adaptation to furniture (PS/BS) (OT, PT)