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 September 1, 2021, additional testing time for ingestion challenge tests (procedure code 95079) will become a benefit of Texas Medicaid.
Procedure code 95079 will become a benefit for physician assistant, nurse practitioner, clinical nurse specialist, and physician providers when services are rendered in the office setting, and for hospital providers when services are rendered in the outpatient hospital setting.
Procedure code 95079 must be billed with primary procedure code 95076 and will be limited to two services per day, any provider.
For more information, call the TMHP Contact Center at 800-925-9126.