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 a correction to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 188.8.131.52.6, “Enteral Supplies.” This subsection incorrectly lists procedure code A4520 and will be updated to list the correct procedure code A5200 with the October 2018 release. Below is the correct statement:
Enteral supplies require prior authorization, with the exception of irrigation syringes (procedure code A4322) and percutaneous catheter or tube anchoring devices (procedure code A5200) within the allowable limits.
For more information, call the TMHP Contact Center at 800-925-9126.