Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
This is an update to the article titled, "Wound Care Equipment and Supply Benefits to Change for Texas Medicaid July 1, 2018," which was published on this website May 11, 2018.
The article stated that effective for dates of service on or after July 1, 2018, prior authorization will be required when quantities exceed the limitations identified for specific procedure codes.
The limitation for procedure code A6250 is two per month. However, procedure code A6250 will continue to require prior authorization for clients who are birth through three years of age, regardless if the limitation has been exceeded.
For more information, call the TMHP Contact Center at 800-925-9126.