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Reimbursement Criteria Updated for Brachytherapy and Therapeutic Radiopharmaceuticals Effective July 1, 2020

Last updated on 5/15/2020

This article has been updated. Click here to see the updates.

Information posted May 15, 2020

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 July 1, 2020, reimbursement criteria will be updated for brachytherapy and therapeutic radiopharmaceuticals for Texas Medicaid.

Brachytherapy

Reimbursement for each service provided using procedure codes 77321 and 77470 are limited to once per two calendar months.

Therapeutic Radiopharmaceuticals

Reimbursement for Strontium-89 chloride will be updated to one service per 90 days for any provider.

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