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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.
On March 28, 2019, TMHP implemented the first quarter 2019 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2019. The HCPCS updates are detailed in this article.
First Quarter 2019 HCPCS Added Procedure Codes
Effective April 1, 2019, the following procedure codes will be added as non-covered procedure codes for Texas Medicaid:
|Clinician Administered Drug (CAD) Procedure Codes|
New benefits adopted by Texas Medicaid must complete the rate hearing process to receive public comment on proposed Texas Medicaid reimbursement rates.
After the rate hearing, expenditures must be approved before Texas Medicaid adopts the rates. Providers will be notified in a future notification if a proposed reimbursement rate will change or if a procedure code will not be reimbursed because the expenditures are not approved.
Providers may also refer to the following website for details related to rate hearings: www.hhs.texas.gov/about-hhs/communications-events/meetings-events.
First Quarter 2019 HCPCS Informational Procedure Codes
The following procedure codes will be added as informational only:
For more information, call the TMHP Contact Center at 800-925-9126.