Information posted June 12, 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 August 1, 2020, circumcisions for newborns (procedure codes 54150 and 54160) will be payable to additional provider types.
Physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives may now be reimbursed for procedure codes 54150 and 54160 rendered in the office and outpatient hospital setting.
For more information, call the TMHP Contact Center at 800-925-9126.