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Reimbursement Rate Updates for Some Texas Medicaid Procedure Codes Effective July 1, 2020

Last updated on 11/3/2020

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 October 29, 2020, for dates of service on or after July 1, 2020, reimbursement rate for procedure codes 90619 and 90694 will be updated for Texas Medicaid.

The following link shows the procedure codes 90619 and 90694 updates: Drugs

Affected claims with dates of service from July 1, 2020, through October 29, 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.