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 update the limitation for procedure code 84583 in the Texas Medicaid Provider Procedures Manual, Radiology and Laboratory Services Handbook, section 2.2.16, “Urinalysis and Chemistry.”
The following statement contains the updated limitation:
Procedure code 84583 will be denied if billed on the same day by the same provider as procedure codes 81000, 81001, 81002, 81003, 81005, or 81020.
For more information, call the TMHP Contact Center at 800-925-9126.