You have unique health needs and we want to help you get the care and support you need to live as independently as possible. program. Download the Sydney Health mobile app from your app store and log in using the same Amerigroup username and password. The Texas Health and Human Services Commission (HHSC) is responsible for the reimbursement determination functions for the Texas Medicaid Program. ALL rights reserved. STAR+PLUS is a Texas Medicaid managed care program for people who have disabilities or are age 65 or older. To get services through STAR+PLUS you must: (1) be approved for Medicaid, (2) be one or more of the following: The following people can't be in the STAR+PLUS program: Important notes for those covered by Medicare: Map of STAR+PLUS Health Plans by Rural Service Area (PDF), More facts about Medicaid managed care initiatives. lock % This site uses cookies and related technologies, as described in our privacy policy. Effective December 1, 2022, Amerigroup is updating the Long-Term Services and Supports (LTSS) Fee Schedules for STAR+PLUS and STAR Kids in Texas. In the Medicaid for Breast and Cervical Cancer program. Use our Report Waste, Fraud or Abuse form to tell us if you suspect waste, fraud or abuse of services we paid for. Set. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. You can get no-cost rides to your health-care services. We are here to help. Amerigroup works with thousands of doctors, specialists, and hospitals throughout Texas, and we partner with many local community organizations. Visit our Medicare site to compare plans. If you have both Medicare and Medicaid, contact your Medicare plan for your vision benefits. Proposed rates are calculated utilizing established methodologies that conform to the Social Security Act and related federal regulations, the federally . $25 for getting a prenatal checkup in the first trimester of pregnancy or within 42 days of joining the health plan, $50 for getting a postpartum checkup within 7 to 84 days after giving birth, Most surgeries, including some outpatient surgeries, All elective and nonurgent inpatient services and admissions, Most behavioral health and substance abuse services (except routine outpatient and emergency services), Certain durable medical equipment, including prosthetics and orthotics, Rehabilitation therapy (physical, occupational, respiratory, and speech therapies), Out-of-area or out-of-network care except in an emergency, Advanced imaging (things like MRAs, MRIs, CT scans, and CTA scans), Certain pain management testing and procedures, Calling Member Services with questions about specific services, Get your service coordinator or case managers phone number and email address, Send your service coordinator or case manager secure messages about your diagnoses, goals, medicines, services, and more, Check due dates and status for goals and objectives, Log in or register first if you don't have an account. Members can get oral interpretation services and information in other formats, like Braille, audio, or large print free of charge. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Applications are available at the American Dental Association web site, http://www.ADA.org. This Agreement will terminate upon notice to you if you violate the terms of the Agreement. Hear Dorothy and Roberts stories and learn more about HHS home and community-based services. Heres how you know. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Well help you with your health-care needs every step of the way. CPT only copyright 2022 American Medical Association. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. People who are not able to get full Medicaid benefits, such as Frail Elderly program members, Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, Qualified Disabled Working Individuals and illegal immigrants. Help you make appointments to see your providers and help you get covered services when you need them. If you ask to change your plan or doctor, you must wait until we tell you the change is made before you go to your new doctor. Amerigroup is proud to offer STAR+PLUS benefits to people who live in our service area, are approved for Medicaid, and meet at least one of the following: Amerigroup offers STAR+PLUS in these service areas: Not sure of your service area? To find an eye doctor and learn about covered services, call Superior Vision of Texas at 1-800-428-8789 or go to the Superior Vision website. Then, use your dollars to pick gift cards to use at your favorite retailers., Online mental health access to a secure website and mobile app to help improve mental and emotional health, anytime you need it, Family members to go with you to medical services, Pregnancy, birthing, or newborn classes for pregnant members, Cellphone or smartphone with monthly minutes, data, and texts, Pest control services once every three months, First aid kit and a personal disaster plan, Plastic/polycarbonate eyeglass lenses every 36 months, Help from a nurse, day or night, to answer your health questions with 24-hour Nurse HelpLine, Respite care hours in order for family members and caregivers to take a break, Up to 20 home-delivered meals after being discharged from a hospital or nursing facility, Taking Care of Baby and Me program for pregnant women and new moms. If your formula is not included in the recall, you can keep using it. Log into Availity Essentials* (https://apps.availity.com/availity/web > Payer Spaces > Amerigroup payer title Resources) to view a copy of the fee schedules. Call us at least two working days before you need a ride. ) Earn Healthy Rewards dollars by doing healthy activities like completing certain checkups or treatments. means youve safely connected to the .gov website. STAR+PLUS does not change how people get their Medicare services. If you need to travel out of town, or out of your service area, call us at least five working days before you need a ride. If recalled, do NOT use it. You can also call 1-800-600-4441 (TTY 711) to request materials in another language or format including audio, braille, or large print. 9/1/2022 Page of TEXAS MEDICAID FEE SCHEDULE -HOME HEALTH AGENCY Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document. The scope of this license is determined by the ADA, the copyright holder. Learn more about consumer directed services. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT "). Age 21 or older, getting Supplemental Security Income (SSI) benefits, and able to get Medicaid due to low income. This file is primarily intended to map Zip Codes to CMS carriers/Medicare Administrative Contractors and localities. Your member handbook can tell you about the available benefits. CDT is a trademark of the ADA. A STAR+PLUS staff member works with the member, the member's family and the member's doctors and other providers to help the member get the medical and long-term services and support they need. A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. 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. Before sharing sensitive information, make sure youre on an official government site. 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. 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. or He or she can tell you about other doctors in our plan and help you coordinate the care you receive. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. Code Procedure Description Fee Code Procedure Description Fee D0120 PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT $26.00 D1553 RE-CEMENT OR RE-BOND UNILATERAL SPACE MAINTAINER- PER QUADRANT $57.00 D0140 LIMITED ORAL EVALUATION-PROBLEM FOCUSED $43.00 D1555 REMOVAL OF FIXED SPACE MAINTAINER $57.00 D0150 COMPREHENSIVE ORAL EVALUATION - NEW OR ES. Medicaid insurance Medicaid is a health insurance program for individuals who meet the income and eligibility requirements. endobj endobj STAR+PLUS and MMP members who were discharged from a NF on or after March 18, 2020, through Aug. 31, 2023, currently do not reside in a NF, and still have NF Medicaid should reach out to their health plan for more information about requesting an upgrade to STAR+PLUS HCBS. You pay nothing except the monthly applied income amount you pay to the nursing facility. Sign up for our Healthy Rewards program and earn rewards for completing healthy activities, like getting certain checkups or screenings. Help in your home with basic daily activities. %PDF-1.7 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. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 20 0 R 23 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Starting September 1, 2020, you can receive these free extra benefits designed to help support you: You can find specific benefit details, including exclusions and limitations, in your member handbook. Adults in STAR+PLUS get Medicaid health-care and long-term services and support through a health plan that they choose. We may also assign one after we look at your health and support needs. Heres how you know. Share sensitive information only on official, secure websites. CMS issued aCY 2023 Medicare Physician Fee Schedule (PFS) final rule to expand access to behavioral health care, cancer screening coverage, and dental care.
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