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Reimbursement Rate Updates for Procedure Codes C9064 and J9227 Effective October 1, 2020

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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 November 24, 2020, for dates of service on or after October 1, 2020, the reimbursement rates for procedure codes C9064 and J9227 will be updated for Texas Medicaid.

The following link shows the procedure codes C9064 and J9227 updates: Drugs

Affected claims with dates of service from October 1, 2020, through November 24, 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.