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 June 28, 2021, Opioid Treatment Providers (OTPs), also referred to as narcotic treatment programs, can access a new Static Fee Schedule that will contain all procedure codes payable to the OTP provider type. The new fee schedule will be available on the Static Fee Schedule page on the TMHP website and will be titled “Outpatient Behavioral Health - Opioid Treatment Provider.” The new Static Fee Schedule was created to clarify allowable billing codes for OTPs. It does not change the rates for these billing codes.
For more information, call the TMHP Contact Center at 800-925-9126.