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Wound Care Procedure Code Benefits Changes Effective March 1, 2022

Last updated on 1/14/2022

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 or 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, wound care management procedure codes Q4173 and Q4174 will become benefits of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program clients. Wound care management procedure codes Q4115 and Q4132 will no longer be benefits effective March 1, 2022.

Reimbursement for Procedure Codes Q4173 and Q4174

Effective March 1, 2022, procedure codes Q4173 and Q4174 can be reimbursed to the following providers for medical services rendered in the following settings:

Place of Service

Provider Type

Office

Physician, dentist, podiatrist providers

Outpatient Hospital

Hospital providers

Note: Procedure codes Q4173 and Q4174 can also be reimbursed to county indigent health-care providers for services rendered in an office setting for Medicaid clients. This provider type is not applicable to the CSHCN Services Program.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.