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 January 1, 2022, and September 1, 2022, reimbursement rate changes and updates for procedure codes presented at a public rate hearing on May 16, 2022, will be implemented.
Effective for Dates of Service on or After January 1, 2022
A change has been made to the Healthcare Common Procedure Coding System (HCPCS) for Procedure Code 93594 TOS 2-I-T.
Affected claims, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.
Effective for Dates of Service on or After September 1, 2022
The following topics were covered at the public rate hearing.
Calendar Fee Review for:
- Birthing Centers
- Cardiovascular System Surgery
- Digestive System Surgery
- G Codes (Acute Care)
- G Codes (Hospitals)
- G Codes (Rural Hospitals)
- K Codes
- Nervous System Surgery
- Personal Care Services (PCS)
- Physician Administered Drugs – Oncology
- Physician Administered Drugs – NDCX
- Physician Administered Drugs – Non-Oncology
- Physician Administered Drugs – Vaccines and Toxoids
- Proton Therapy
- Respiratory System Surgery
- T Codes
- Urinary System Surgery
- Vision Devices
Healthcare Common Procedure Coding System (HCPCS) for:
Medical Policy Review for:
Special Review for:
For More Information:
- Refer to the Health and Human Services (HHS) Rate Analysis web page at hhs.texas.gov/rate-packets.
- Call the TMHP Contact Center at 800-925-9126.