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New Prosthesis Benefits for Texas Medicaid Effective July 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 July 1, 2025, prosthesis procedure codes L5827 and L6700 will be benefits of Texas Medicaid.

Procedure codes L5827 and L6700 will require prior authorization and be limited to clients who are birth through 20 years of age. Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.20.2, “Prior Authorization and Documentation Requirements,” for additional information about prior authorization criteria.

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