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 July 2, 2019, for dates of service on or after October 1, 2018, Clinician-Administered Drugs procedure code J0606, Parsabiv, is no longer a benefit of Texas Medicaid.
Affected claims, if any, identified with dates of service on or after October 1, 2018, will deny as part of another service.
Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
For more information, call the TMHP Contact Center at 800-925-9126.