Skip to main content

Reimbursement Rate Updates Presented at Public Rate Hearing on February 5, 2021 to Be Effective January 1, 2021

Last updated on

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, 2021, reimbursement rate changes and updates for the Annual Healthcare Common Procedure Coding System (HCPCS) procedure codes that were presented at a public rate hearing on February 5, 2021 will be implemented.

Effective for Dates of Service On or After January 1, 2021

Annual Healthcare Common Procedure Coding System:

TMHP will automatically reprocess affected claims, if any are identified; providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.

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