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 January 1, 2019, procedure code T4528 with modifier U1 will no longer be a benefit of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program.
Procedure code T4528 without modifier U1 will remain a benefit of Texas Medicaid and the CSHCN Services Program. Providers may refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 18.104.22.168, “Diapers, Briefs, Pull-ons, and Liners,” for benefit information about procedure code T4528.
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.