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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

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SHARS - Updates to Interim Claiming and Cost Reporting Requirements for SHARS PT, OT, ST, and Audiology Services

Last updated on 9/14/2021

This article has been updated. For the updated information, click here.

The Texas Health and Human Services Commission (HHSC) must update interim claiming and cost reporting requirements for School Health and Related Services (SHARS) Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), and Audiology services in accordance with Title 42 Code of Federal Regulations (CFR) §455.440 National Provider Identifier, CFR §455.410 Enrollment and Screening of Providers, and CFR §440.110 Physical Therapy, Occupational Therapy, and Services for Individuals with Speech, Hearing, and Language Disorders.

These updates are necessary to mitigate potential interim claiming and cost reporting denials due to a missing referring or prescribing provider National Provider Identifier (NPI). All referring and prescribing providers, regardless of direct employment with school districts, must obtain an NPI and must be enrolled in Medicaid as individual practitioners.

The following updates for SHARS PT, OT, ST, and Audiology services will be effective October 1, 2021:

Definitions for Prescription and Referral

Prescription and referral are defined as follows:

A prescription is a written order for services (such as PT or OT) from the ordering physician or other eligible prescribing provider.
A referral is a written document requesting evaluation for services (such as ST or Audiology) from the referring physician or other eligible referring provider.

Physical and Occupational Therapy

A prescription is required for all PT and OT services to receive SHARS reimbursement. The prescription must be updated a minimum of one time every three calendar years.
A physician or another eligible prescribing provider must prescribe PT and OT services.
- Prescriptions for PT and OT services must be signed and dated within three calendar years before the initiation of services.
- PT and OT services may be reimbursed up to, but no more than, the amount designated on the prescription.
The name and NPI of the licensed physician or other eligible prescribing provider must be listed on the claim and kept in the medical record for PT and OT services to be reimbursed through SHARS.

Speech Therapy and Audiology

A referral is required for all ST and Audiology services to receive SHARS reimbursement. The referral must be updated a minimum of one time every three calendar years.
A physician or another eligible referring provider must refer for ST and Audiology services.
Referrals for ST or audiology services must be signed and dated within three calendar years before the initiation of services.
The name and NPI of the referring licensed physician or another eligible referring provider must be listed on the claim and kept in the medical record for reimbursement of ST or Audiology services through SHARS.
- STs and audiologists whose evaluations serve as the referral must be enrolled in Medicaid as individual practitioners and must use their individual NPIs when submitting claims.

Notes:

This change means SHARS providers must provide a prescribing or referring NPI provider number for PT, OT, ST and Audiology services only.
No other services rendered by SHARS providers require a prescribing or referring NPI.

For more information, call the TMHP Contact Center at 800-925-9126.