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 July 1, 2020, claims submitted for services with Modifier GZ for Texas Medicaid will be denied. Services submitted with modifier GZ are not covered and considered not reasonable or necessary.
Affected claims submitted with dates of service from July 1, 2020, through July 6, 2021, with modifier GZ, may be reprocessed. Affected claims may be recouped, which will be reflected on future Remittance and Status Reports. No action on the part of the provider is required.
For more information, call the TMHP Contact Center at 800-925-9126.