Information posted June 17, 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, TMHP will update the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians and Physicians Assistants Handbook, section 188.8.131.52 “Brachytherapy.”
Procedure codes 77316, 77317, and 77318 will be removed from the following statement to reflect changes to reimbursement criteria:
Each service provided using procedure codes 77316, 77317, 77318, 77321 and 77470 are limited to once per two calendar months.
For more information, call the TMHP Contact Center at 800-925-9126.