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.
TMHP has updated the limitation for diabetic equipment and supplies procedure code A9276.
Effective for dates of service on or after September 1, 2021, diabetic equipment and supplies procedure code A9276 will be limited to 30 services allowed per 30 days (one unit equals a one-day supply), same procedure, any provider.
Claims submitted with dates of service on or after September 1, 2021, through November 30, 2021, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing has been completed.
For more information, call the TMHP Contact Center at 800-925-9126.