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Reimbursement Rate Updates for Procedure Code J1095 Effective April 1, 2020

Last updated on 8/12/2020

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 August 13, 2020, for dates of service on or after April 1, 2020, the reimbursement rate for procedure code J1095 will be updated.

The following table shows the updates:

Affected claims with dates of service from April 1, 2020, through August 13, 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.