This notification has been corrected. For the corrected information, click here.
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 January 1, 2021, and September 1, 2021, reimbursement rate changes and updates for procedure codes presented at a public rate hearing on May 25, 2021, will be implemented.
The following topics were covered at the public rate hearing:
Effective for dates of services on or after January 1, 2021
- Calendar Fee Review for Indian Health Services (IHS) Procedure Code 1-T1015
- Affected claims, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.
Effective for dates of services on or after September 1, 2021
- Calendar Fee Review for:
- Any Combination 1/2/I/T
- Diagnostic Radiology - Non-hospital
- DME E Codes Respiratory Equipment
- Evaluation and Management
- Hearing Aids
- Medical Nutrition Therapy
- Nonclinical Laboratory
- Nonclinical Laboratory – Hospitals
- Nonclinical Laboratory – Rural Hospitals
- Physician Administered Drugs Non-Oncology
- Physician Administered Drugs Non-Oncology (Medically Assisted Treatment)
- Physician Administered Drugs Oncology
- Physician Administered Drugs Vaccines
- S codes TOS 1, 2, 8
- S Codes TOS 9, E, J
- Telemedicine, Telehealth, and Telemonitoring
- Healthcare Common Procedure Coding System (HCPCS) for:
- Medical Policy Review for:
- Allergy Testing
- Cervical Total Disc Replacement TOS 2-8
- Cervical Total Disc Replacement TOS F
- Cytogenic Constitutional (Genome-wide) Microarray Analysis
- Diabetic Equipment and Supplies – CCP & Home Health (adding adjunct CGM)
- HEP B Vaccine
- Subcutaneous Implantable Cardio Defibrillator TOS 2, I, T
- Subcutaneous Implantable Cardio Defibrillator TOS F
- Transversus Abdominis Plane (TAP) Blocks TOS 2
- Transversus Abdominis Plane (TAP) Blocks TOS F
For more information:
- Refer to the Health and Human Services (HHS) Rate Analysis web page at hhs.texas.gov/rate-packets.
- Call the TMHP Contact Center at 800-925-9126.