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 April 1, 2020, the second quarter 2020 National Correct Coding Initiative (NCCI) updates will be implemented for claims processed by TMHP for Texas Medicaid.
Providers may refer to the Centers for Medicare & Medicaid Services (CMS) website at www.medicaid.gov/medicaid/program-integrity/ncci/index.html for the updated Medicaid NCCI rules, relationships, and general information. A link to the CMS Medicaid NCCI website is also available on the Code Updates – NCCI Compliance web page on TMHP.com.
Providers are encouraged to monitor the CMS website regularly for updates to the Medicaid NCCI rules and guidelines.
Health Behavior Intervention
Health and Behavior Assessment and Intervention (HBAI) benefits will be updated to align with the second quarter 2020 NCCI updates.
Effective April 1, 2020, procedure codes 96170 and 96171 will no longer be reimbursed. Procedure codes 96167 and 96168 will be the only health behavior intervention services, which include the client’s family, that may be reimbursed when the family member directly participates in the overall care of the client.
For more information, call the TMHP Contact Center at 800-925-9126.