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, 2022, the reimbursement rates for some 2021 fourth quarter healthcare common procedure coding system (HCPCS) procedure codes will be implemented for Texas Medicaid.
To view the updates, click the following link: Fourth Quarter 2021 HCPCS Drugs
For more information, call the TMHP Contact Center at 800-925-9126.