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.
Beginning February 1, 2019, TMHP will update the Texas Medicaid Provider Procedures Manual, Clinics and Other Outpatient Facility Services Handbook, Section 4.1.2, “Services, Benefits, Limitations, and Prior Authorization.” Within the note statement for procedure codes 96160 and 96161, the benefit limitation will be corrected to read “once per calendar year, any provider.”
For more information, call the TMHP Contact Center at 800-925-9126.