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 September 1, 2021, reimbursement rate updates for procedure codes presented at a public rate hearing on July 12, 2021, will be implemented.
The following links show the updates:
- Clinical Diagnostic Laboratory Services
- Clinical Diagnostic Laboratory Services – Gapfill
- Diagnostic Radiology – Rural Hospitals
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.