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Medical Transportation Fee-for-Service Demand Response Transportation Services Providers (including Transportation Network Companies) Reimbursement Information for Procedure Code T2003

Last updated on 7/20/2021

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 1, 2021, Texas Medicaid & Healthcare Partnership (TMHP) has been processing medical transportation claims for Demand Response Transportation Services (DRTS) providers statewide for clients enrolled in the following programs:

  • Medicaid fee-for-service
  • Children with Special Health Care Needs (CSHCN) Services Program
  • Transportation for Indigent Cancer Patients

Providers must use the new procedure code T2003 when submitting claims for reimbursement.

The Texas Medical Transportation System (TMTS) will continue to authorize service requests per one-way ride (leg) and issue a unique authorization number per leg. Providers are responsible for submitting a claim for each leg and authorization number of the trip completed.

Procedure Code

Modifier

Medicaid Fee

Reimbursement Information

T2003

U1 (Metro/Urban County)

$27.06

Providers will be reimbursed at a rate of $27.06 per leg for trips completed in accordance with contract requirements. Reimbursement will be calculated by the number of seats authorized by the Health and Human Services Commission (HHSC) for each leg of the trip.

Examples:

· 2 passengers x $27.06 = $54.12 per authorization (leg).

· 2 legs x $54.12 = $108.24.

T2003

U2 (Rural County)

$63.71

Providers will be reimbursed at a rate of $63.71 per leg for trips completed in accordance with contract requirements. Reimbursement will be calculated by the number of seats authorized by HHSC for each leg of the trip.

Examples:

· 2 passengers x $63.71 = $127.42 per authorization (leg).

· 2 legs x $127.42 = $254.84.

T2003

U3 (Micro/Suburban County)

$49.85

Providers will be reimbursed at a rate of $49.85 per leg for trips completed in accordance with contract requirements. Reimbursement will be calculated by the number of seats authorized by HHSC for each leg of the trip.

Examples:

· 2 passengers x $49.85 = $99.70 per authorization (leg).

  • 2 legs x $99.70 = $199.40.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.