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.
As part of the continued response to the Coronavirus (COVID-19) public health emergency, diagnosis restrictions have been removed from the COVID-related procedure codes listed in this table on or after the dates of service listed in the table.
Affected claims submitted on or after the listed date of service will be reprocessed, and providers may receive an additional payment, which will be reflected on future Remittance and Status (R&S) Reports. For more information, call the TMHP Contact Center at 800-925-9126.