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Updates to the Texas Medicaid Provider Procedures Manual Beginning August 1, 2020

Last updated on 7/3/2020

Information posted July 3, 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.

Beginning August 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians and Physician Assistants Handbook and Vision and Hearing Services Handbook to update benefit criteria.

Updates to Medical and Nursing Specialists, Physicians and Physician Assistants Handbook

Section 9.2.26 Diagnostic Doppler Sonography

The changes are as follows:

  • Procedure codes 93307, 93320, and 93321 will no longer be required to be billed with procedure code 93325 to be considered for reimbursement.
  • Procedure code 93351 will be added to the table below.

Doppler echocardiography color flow mapping (procedure code 93325) must be billed with one of the corresponding procedure codes in column B to be considered for reimbursement:

Column A Procedure Code  Column B Procedure Codes 
93325 76825, 76826, 76827, 76828, 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, or 93351

Section 9.2.46.6 Other Eye Surgery Limitations

The changes are as follows:

  • Procedure code 67112 will no longer be a benefit.
  • Procedure code 66990 may be reimbursed when procedure code 67113 has been paid to the same provider on the same date of service.
  • Procedure codes 67335 and 67340 may be reimbursed when procedure codes 67320, 67331, 67332, or 67334 has been paid to the same provider on the same date of service.

In the following table, the procedure codes in Column A may be reimbursed only when at least one corresponding procedure code from Column B has been paid to the same provider for the same date of service:

Column A Procedure Codes Column B Procedure Codes
66990 65820, 65875, 65920, 66985, 66986, 67036, 67039, 67040, 67041, 67042, 67043, or 67113
67320, 67331, 67332, 67334 67311, 67312, 67314, 67316, or 67318
67335, 67340 67311, 67312, 67314, 67316, 67318, 67320, 67331, 67332, or 67334
V2790 65780

Update to Vision and Hearing Services Handbook

Section 2.2.3.7 Limitations

Electrical testing (procedure code 92547) must be billed with the same date of service by the same provider as procedure codes 92540, 92541, 92542, 92544, 92545, or 92546.

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