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Clarification Language for After-Hours Services Limitation Effective February 1, 2020

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.

Beginning February 1, 2020, TMHP will add clarifying language for after-hours services to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.57.3.6, “After-Hours Services,” and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, section 31.2.18.5, “Services Outside of Business Hours.”

The following statement will be added to clarify the after-hours limitation:

After-hours procedure codes are limited to one per day, same provider.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.