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 November 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician’s Assistant Handbook, section 188.8.131.52, “Pediatric Pneumogram,” and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Chapter 31, section 184.108.40.206, “Pediatric Pneumogram,” to clarify the limitation of two services per lifetime.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.