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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 2. Medicaid Title XIX family planning services : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.6 Drugs and Supplies

2.2.6
The following procedure codes may be reimbursed for drugs and supplies:
Procedure codes A4268, A4269, and S4993 may be reimbursed when they are billed with one of the following diagnosis codes:
Procedure code A9150 for the medication to treat a monilia infection is not reimbursed through Title XIX Medicaid. The drug is available through the Medicaid Vendor Drug Program with a prescription.
Refer to:
Appendix B: Vendor Drug Program (Vol. 1, General Information) for information about outpatient prescription drugs and the Medicaid Vendor Drug Program.

Texas Medicaid & Healthcare Partnership
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