Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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 March 1, 2022, prior authorization will be required for laser interstitial thermal therapy (LITT) procedure codes 61736 and 61737 in Texas Medicaid.
LITT, an intraoperative magnetic resonance imaging (MRI) procedure, will be considered for prior authorization when the following medical necessity criteria have been met:
- The client has one of the following documented diagnoses:
- Relapsed brain metastasis
- Acute cerebrovascular insufficiency
- Radiation necrosis
- Secondary malignant neoplasm of the brain
- The client is not a surgical candidate.
Refer to the current Texas Medicaid Provider Procedures Manual, Radiology and Laboratory Services Handbook, subsection 3.2.6, “Authorization Requirements for CT, CTA, MRI, fMRI, MRA, PET, and Cardiac Nuclear Imaging Services” for additional information about requesting prior authorization.
Procedure codes 70557, 70558, and 70559 must not be billed in conjunction with procedure code 61736 or 61737.
For more information, call the TMHP Contact Center at 800-925-9126.