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 drug procedure codes have been implemented for Texas Medicaid.
To view the updates, click the following link: Drugs
For more information, call the TMHP Contact Center at 800-925-9126.