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Updates to the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook

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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.

The June 2022 release of the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook will be updated to remove procedure codes J9219, J9600, and Q0139 as follows:

Procedure Code

Affected Subsection

Additional Information

J9219

7.57 “Leuprolide Acetate (Lupron Depot)”

Procedure code is not a benefit. All other procedure codes in this subsection remain a benefit of Texas Medicaid.

J9600

7.7.16 “Porfimer (Photofrin)”

Procedure code is not a benefit.

Q0139

7.53 “Iron Injections”

Refer to the Clinics and Other Outpatient Facility Services Handbook, subsection 6.2.2, “Renal Dialysis Facilities-Consolidated Billing,” for information about procedure code Q0139.

For more information, call the TMHP Contact Center at 800-925-9126.