Texas Medicaid: Long-term skilled-nursing prior authorization requirement

UnitedHealthcare Community Plan of Texas members will need to contact a service coordinator to request long-term skilled nursing. This applies to procedure codes S9123 or S9124.

This means, you shouldn’t submit prior authorization requests to us for procedure codes S9123 and S9124. Instead, if you believe our member needs long-term skilled nursing care, you must reach out to one of our service coordinators for a patient assessment.

Long-term skilled nursing prior authorization process

Patient assessments are completed by service coordinators. For individuals receiving Home and Community-Based Services (HCBS) or Long-Term Services and Supports (LTSS), these assessments are submitted to the Texas Health and Human Services Commission (HHSC) for review and HCBS or LTSS eligibility. HHSC then makes the final determination.

To reach a service coordinator, please call 800-349-0550 for STAR+PLUS.

Home and Community Based Services waiver members in STAR+PLUS Medicaid programs may be eligible for long-term skilled nursing for care of 6 months or longer, if services are still medically necessary.

Long-term skilled nursing procedure codes

• S9123 is the procedure code used for long-term skilled nursing care in the home by a registered nurse
• S9124 is the procedure code used for long-term skilled nursing care in the home by a licensed vocational nurse

Acute skilled nursing care

All UnitedHealthcare Community Plan members may be eligible for acute home health skilled nursing services. This applies to procedure codes G0299 or G0300, if the services are medically necessary.

Acute skilled nursing prior authorization process

If you believe our member, your patient, needs acute skilled nursing care, you can:

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
  • If you don’t have a One Healthcare ID, register now
• From the left-hand tabs, select Prior Authorizations & Notifications

Acute skilled nursing care codes

• G0299 is the procedure code used for direct skilled nursing services by a registered nurse in the home health or hospice setting
• G0300 is used for direct skilled nursing services by a licensed practical nurse in the home health or hospice setting