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 September 1, 2020, botulinum toxin type A and B benefits for Texas Medicaid will be updated to allow reimbursement for the amount discarded (unused). Providers must include modifier JW on a separate claim line for consideration of reimbursement for the unused portion of single-dose vials.
Providers may refer to the current Texas Medicaid Provider Procedures Manual, Clinician-Administered Drugs Handbook, subsection 4, “Reimbursement,” for additional information about reimbursement for the unused portion of weight-based or variable dosing clinician-administered drugs that are only manufactured in single-dose vials.
For more information, call the TMHP Contact Center at 800-925-9126.