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Issue Resolved for Ambulatory EEG Claims

Last updated on 8/25/2020

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.

TMHP has resolved an issue that caused some ambulatory electroencephalogram (EEG) claims to be inappropriately rejected. The issue caused claims billed with certain procedure codes without modifiers 26 or TC to be inappropriately rejected. Click here to see the table of procedure codes.

Claims meeting these criteria that were rejected can be resubmitted for processing.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.