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Reimbursement Rate Updates for Prostate Surgeries Procedure Codes Effective October 1, 2021

Last updated on 8/13/2021

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 for dates of service on or after October 1, 2021, reimbursement rate updates for Prostate Surgeries procedure codes presented at a public rate hearing on May 25, 2021, will be implemented.

The following links show the updates:

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.