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Limitation Update for Diabetic Equipment and Supplies Procedure Code A4245

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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.

Effective July 1, 2022, for dates of service on or after March 1, 2022, up to 4 boxes of alcohol wipes may be reimbursed for clients with diabetes mellitus using procedure code A4245. When submitting claims for clients with diabetes mellitus, providers must use modifier U4.

The 95-day claims filing deadline will be waived so that providers can refile claims with dates of service between March 1, 2022, and July 1, 2022, to append modifier U4 for clients with diabetes mellitus, allowing the claim to exceed the limitation of one box per month.

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