Information posted July 21, 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 July 9, 2020, for dates of service on or after July 1, 2020, the reimbursement rate for procedure code J0896 (Reblozyl) has been updated.
The following table shows the updates:
|Type of Service: Medical Services||Procedure Code||Age Range||Non-Facility (N)/
|Current Medicaid Fee||Percent Reduction||Current Adjusted Medicaid Fee||Medicaid Fee Effective 7/1/2020||Percent Reduction||Adjusted Medicaid Fee Effective 7/1/2020|
|1||J0896||18-999||N/F||Not a Benefit||0.00%||Not a Benefit||$36.95||0.00%||$36.95|
Affected claims with dates of service from July 1, 2020, through July 9, 2020, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.
For more information, call the TMHP Contact Center at 800-925-9126.