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 September 9, 2021, for dates of service on or after July 1, 2021, the reimbursement rates for drug procedure code Q5123 for Texas Medicaid will be implemented.
To view the updates, click the following link: Procedure Code Q5123
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 claim reprocessing is completed.
For more information, call the TMHP Contact Center at 800-925-9126.