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News update

Apr 08, 2026

Orthotists in the CSHCN Services Program Should Review the L6028 Procedure Code Update

A significant reimbursement policy change has been announced affecting orthotists enrolled in the Children with Special Health Care Needs (CSHCN) Services Program. Effective April 2, 2026, procedure code L6028 will no longer be reimbursable for orthotists for dates of service on or after April 1, 2025.

However, TMHP has confirmed that reimbursement for procedure code L6028 may still be available when billed by prosthetists and durable medical equipment (DME) suppliers, provided all applicable billing guidelines and requirements are met.

For additional details or clarification, providers can contact the TMHP-CSHCN Services Program Contact Center at 800-568-2413.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

Eligibility Verification

Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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