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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 : 4.2.11 Fluocinolone Acetonide : Prior Authorization for Fluocinolone Acetonide
To request prior authorization, providers must submit requests by fax or mail to the SMPA Department at:
Texas Medicaid & Healthcare Partnership
Special Medical Prior Authorization
12357-B Riata Trace Parkway
Austin, TX 78727
Fax: 1-512-514-4213
Requests for prior authorization can be submitted online through the TMHP website at

Texas Medicaid & Healthcare Partnership
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