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Reimbursement Rate Updates for Indian Health Services Procedure Code T1015 Effective January 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 for dates of service on or after January 1, 2020, the reimbursement rate updates for Indian Health services procedure code T1015 that were presented at a public rate hearing on November 13, 2020, are now available.

For dates of service on or after January 1, 2020, the reimbursement rate for Indian Health Services procedure code T1015 has increased from $455.00 to $479.00 for clients of all ages.

The following link shows the updates: Indian Health Services

Affected claims with dates of service from January 1, 2020, through December 31, 2020, will automatically be reprocessed. Providers are not required to appeal claims unless they are denied for additional reasons after the claims reprocessing is complete. Providers with affected claims may receive additional payment, which will be reflected on future Remittance and Status Reports.

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