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Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes Effective January 1, 2025

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after January 1, 2025, reimbursement rate changes and updates for the procedure codes that were presented at the public rate hearing on February 14, 2025, have been implemented.

The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any affected claims that are identified. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed.

The following 2025 Healthcare Common Procedure Coding System (HCPCS) Review topics were covered at the hearing:

For more information, call the TMHP Contact Center at 800-925-9126.