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Reimbursement Rate Updates for Procedure Codes C9058 and Q5120

Last updated on 9/14/2020

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 July 30, 2020, for dates of service on or after April 1, 2020, and July 1, 2020, the reimbursement rates for procedure code C9058 and procedure code Q5120 have been updated.

Effective for dates of services on or after April 1, 2020

The following link shows the updates: Procedure Code C9058 

Affected claims with dates of service from April 1, 2020, through June 30, 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.

Effective July 31, 2020, procedure code C9058 has been replaced by procedure code Q5120.

Effective for dates of services on or after July 1, 2020

The following link shows the updates: Procedure Code Q5120 

Affected claims with dates of service from July 1, 2020, through July 30, 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.