Vitamins and minerals are available to people 20 years of age and younger enrolled in Medicaid, the Children’s Health Insurance Program (CHIP), and the Children with Special Health Care Needs (CSHCN) Services Program. Pharmacies are not required to enroll as a durable medical equipment (DME) provider or in the Medicaid Comprehensive Care Program to provide access to covered vitamins and minerals. Pharmacies already enrolled as a Medicaid DME or CCP provider have the choice to submit claims as either:
- Medical benefit
- Claims are submitted to the Texas Medicaid Healthcare Partnership (TMHP)
- Pharmacy benefit:
- Claims for traditional Medicaid and the CSHCN Services Program are submitted to VDP. Pharmacy staff should refer to the pharmacy benefit chart in the Pharmacy Provider Procedure Manual for covered products, quantity guidelines, refill limitations, and reimbursement rates.
- Claims for Medicaid managed care and CHIP are submitted to the managed care organization. Pharmacy staff should contact the MCO's pharmacy benefit manager to identify billing requirements, reimbursement rates, and coverage limitations.
Certain vitamin and mineral products prescribed or ordered by a prescribing provider to treat various conditions are a covered benefit through the Medicaid Comprehensive Care Program for people who are 20 years of age and younger. For traditional Medicaid and the CSHCN Services Program these products are billed to TMHP, manually priced, and are a benefit when they are prior authorized and submitted with the corresponding procedure code and state-identified modifier.
Refer to the Vitamins and Minerals chapter of the Pharmacy Provider Procedure Manual to learn more.