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.
Effective for dates of service on or after December 1, 2018, the quantity limitation of medication for botulinum toxin type A procedure code J0586 will change for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.
Procedure code J0586 will be limited to 1,500 units of medication.
Note: One billing unit is equal to five units of medication. If a provider administers 1,500 units of medication, the claim would be submitted for a quantity of 300.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.