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 March 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Inpatient and Outpatient Hospital Services Handbook, subsection 22.214.171.124, “Pentamidine Aerosol,” to remove diagnosis restrictions for procedure codes 94642 and J2545. The removal of this subsection will not affect current benefit coverage.
For more information refer to the Aerosol Treatment Benefits to Change for Texas Medicaid article, which was published December 18, 2015.
For more information, call the TMHP Contact Center at 800-925-9126.