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Ambulatory and Long-Term Electroencephalogram Benefits to Change for Texas Medicaid October 1, 2020

Last updated on 8/14/2020

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 October 1, 2020, ambulatory and long-term electroencephalogram (EEG) benefits will change for Texas Medicaid.

The time increment for each unit will no longer be 24 hours. The amount of time included in each unit for the following procedure codes is defined in the procedure code description:

Procedure Codes

95705

95706

95707

95708

95709

95710

95711

95712

95713

95714

95715

95716

95717

95718

95719

95720

95721

95722

95723

95724

95725

95726

           

Providers may contact the appropriate copyright holder to obtain procedure code descriptions.

Procedure code 95700 will be limited to 3 units per 6 months for each physician for the same client, in addition to the 3 units allowed for the procedure codes listed in the table above.

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