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.
Beginning May 1, 2022, Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook section 3.2.15, “Restorative Services.”
The table titled “Inlay/Onlay Restorations (Permanent Teeth only)” will include the following updates:
- The word “inlays” will be removed from the following statement:
Prior authorization is required for all inlays/onlays or permanent crowns.
- The following statement will be added to the table:
Additional onlays may be considered with prior authorization and documentation of medical necessity.
The table titled ”Crowns—Single Restorations Only” will be updated to include the following statement:
Additional crowns and onlays may be considered with prior authorization and documentation of medical necessity.
For more information, call the TMHP Contact Center at 800-925-9126.