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Allergy Testing Evaluation and Management Limitation Language Updated

Last updated on 12/13/2019

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 February 1, 2020, allergy testing evaluation and management (E/M) services benefit language will be updated in the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.5.2, “Allergy Testing.”

The following statement will be added to align with policy updates:

E/M services will not be reimbursed on the same date of service as allergy testing. Allergy testing will be paid and the E/M service will be denied as part of another procedure on the same date of service.

For more information, call the TMHP Contact Center at 800-925-9126.