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Effective September 1, 2021, Chromosomal Microarray to Become A Benefit of 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 September 1, 2021, procedure code 81229 for cytogenetic constitutional microarray analysis, also called genomic or chromosomal microarray (CMA), will become a benefit of Texas Medicaid for laboratory providers.

CMA detects chromosomal abnormalities for clients who have a chromosomal disorder that often requires complex medical management.

Procedure code 81229 for CMA is a benefit once per lifetime for diagnostic purposes, when appropriate, for children with developmental disabilities or congenital anomalies, women who undergo prenatal diagnostic procedures, and products of conception resulting from recurrent miscarriage. Exceptions to the one-per-lifetime limitation will be made with documentation of medical necessity (e.g., subsequent pregnancies).

Procedure code 81229 will be subject to Clinical Laboratory Improvement Amendment (CLIA) edits.

Reminder: Providers must have the required CLIA certification on file with TMHP.

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