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 April 1, 2019, the second quarter 2019 National Correct Coding Initiative (NCCI) updates will be implemented for claims processed by TMHP for Texas Medicaid.
Providers may refer to the Centers for Medicare & Medicaid Services (CMS) website for the updated Medicaid NCCI rules, relationships, and general information. A link to the CMS Medicaid NCCI website is also available on the Code Updates – NCCI Compliance web page on TMHP.com.
Providers are encouraged to monitor the CMS website regularly for updates to the Medicaid NCCI rules and guidelines.
Contraceptive Procedure Codes J7303 and J7304
Per CMS guidance, procedure codes J7303 and J7304 will be exempt from existing NCCI Medically Unlikely Edit (MUE) limitations, to allow providers to dispense up to a one-year supply in a 12-month period.
The one-year supply may be dispensed on a single date of service.
For more information, call the TMHP Contact Center at 800-925-9126.