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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4 Outpatient Hospital (Medical and Surgical Acute Care Outpatient Facility) : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.9 Computed Tomography and Magnetic Resonance Imaging

Prior authorization is required for all outpatient nonemergent (i.e., those that are scheduled) CT, computed tomography angiography (CTA), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) studies before services are rendered. Authorization is not required for the emergency department or inpatient hospital radiology services. Retroactive authorization may be required for some outpatient emergent studies.
Reimbursement for procedures with descriptions that specify “with contrast” include payment for contrast materials. Some diagnostic radiopharmaceuticals are benefits of Texas Medicaid. Outpatient hospitals may submit the total component of the following procedure codes:
Procedure code 77399 may be submitted as either the total component or the technical component.
Providers can refer to the OFL or the applicable fee schedules on the TMHP website at to review the diagnostic radiopharmaceuticals that are reimbursed by Texas Medicaid. OFL and static fee schedules available on the TMHP website display fees after applicable rate reductions have been applied. Previously, the OFL and static fee schedules did not reflect all rate reductions, and providers were required to calculate the 1- and 2-percent reductions implemented.
Refer to:
Subsection 4.2.9, “Computed Tomography and Magnetic Resonance Imaging,” in the Radiology and Laboratory Services Handbook (Vol. 2, Provider Handbooks), for additional information about prior authorization requirements.
Subsection 3.2.6, “Authorization Requirements for CT, CTA, MRI, fMRI, MRA, PET, and Cardiac Nuclear Imaging Services,” in the Radiology and Laboratory Services Handbook (Vol. 2, Provider Handbooks) for additional information about emergency outpatient imaging services.

Texas Medicaid & Healthcare Partnership
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