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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 January 1, 2020, reimbursement rate changes and updates for Annual Healthcare Common Procedure Coding System (HCPCS) procedure codes that were presented at a public rate hearing on January 28, 2020, will be implemented.
At this time, providers are not required to seek Medicare reimbursement for dual eligible clients for telemonitoring codes 99421, 99422, and 99423.
Effective for dates of service on or after January 1, 2020
- Annual Healthcare Common Procedure Coding System:
- Ambulatory Surgical Centers/Hospital Ambulatory Surgical Centers
- Blood Products
- Clinical Diagnostic Laboratory Services
- Dental Services
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
- Hospital Diagnostic Imaging
- Non - Drugs
- Nonclinical Laboratory Services
- Physician Administered Drugs
- Radiology Services
- Surgery and Assistant Surgery
TMHP will automatically reprocess affected claims, if any are identified. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
For more information, providers may refer to the HHSC Rate Analysis web page at rad.hhs.texas.gov/rate-packets.
For more information, call the TMHP Contact Center at 800-925-9126.