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Effective March 1, 2021, Benefits for Medication Assisted Treatment Services to Change for Texas Medicaid

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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 for dates of service on or after March 1, 2021, benefits for medication assisted treatment services will change for Texas Medicaid.

Opioid Treatment Providers (OTPs) will be added as a provider type for procedure codes J0570, J2315, Q9991, and Q9992.

Reminder: OTPs billing claims for persons who have dual eligibility for Medicaid and Medicare must first submit their claims to Medicare.

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