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 November 1, 2019, some medication assisted treatment (MAT) benefits will change for Texas Medicaid.
Overview of Benefit Changes
Changes to this medical benefit policy include the following:
- Additional payable provider types for some MAT services
- New procedure code for non-methadone administration
Additional Payable Provider Types
The criteria for appropriately trained advanced practice registered nurses who deliver MAT in the office setting will expand to include additional specialties as follows:
- The advanced practice registered nurse must be recognized by the Texas Board of Nursing as a nurse practitioner (NP), clinical nurse specialist (CNS), nurse anesthetist, or nurse midwife
- The advanced practice registered nurse must meet both of the following criteria:
- Must be a qualifying practitioner
- Must possess the appropriate Drug Addiction Treatment Act (DATA) waiver
To align with the updated guidelines, certified registered nurse anesthetists (CRNAs) and certified nurse midwives (CNMs) will be added as additional payable provider types for procedure codes J0570, Q9991, and Q9992, when services are provided in the office setting.
Reminder: MAT services may also be delivered by appropriately trained physicians and physician assistants (PAs) in the office setting.
Procedure Code for Non-Methadone Administration
Non-methadone administration procedure code H2010 will be directly replaced by procedure code H0033.
Procedure code H0033 will be a benefit when services are provided as follows:
- By CNS, CRNA, CNM, NP, PA, and physician providers in the office setting
- By chemical dependency treatment facility providers in the outpatient setting
Note: New benefits that are 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 the rates are adopted by Texas Medicaid. Providers will be notified in a future banner message or 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
Current benefit limitations and requirements for non-methadone administration (procedure code H2010) will also apply to procedure code H0033.
Note: Providers may refer to the current Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook, subsection 9.11.2, “MAT Services,” for more information about limitations and requirements for non-methadone administration.
For more information, call the TMHP Contact Center at 800-925-9126.