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Benefit Limitation Updates Effective October 1, 2021

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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 October 1, 2021, TMHP will update the following sections within the Texas Medicaid Provider Procedures Manual:

  • Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, section 2.2.18.1, “Enteral Nutritional Products, Feeding Pumps, and Feeding Supplies.”
  • Medical and Nursing Specialists, Physicians and Physicians Assistants Handbook, section 9.2.24.2, “Developmental Testing,” and section 9.2.24.3, “Assessment of Aphasia.”

Enteral Nutritional Products, Feeding Pumps, and Feeding Supplies

The limitation for procedure codes B4087 and B4088 will be updated from “2 per rolling year” to “as needed” for clients who are ages 20 and younger.

Developmental Testing

The limitation for procedure codes 96112 and 96113 will be updated to two services per rolling year, any provider.

Assessment of Aphasia

The limitation for procedure code 96105 will be updated to two services per rolling year, any provider.

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