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Changes to Case Management for Children and Pregnant Women, Including Teleservices, Effective September 1, 2022

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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 September 1, 2022, case management benefits for children and pregnant women will change for Texas Medicaid.

Overview of Benefit Changes

Major changes to this benefit include the following:

  • New billing guidelines for Medicaid managed care clients
  • Addition of synchronous audiovisual visit benefits
  • New procedure code and modifier combinations for submitting claims

Medicaid Managed Care Clients

Case management for children and pregnant women services will no longer be carved out of Medicaid managed care.

For services delivered through a managed care organization (MCO), providers must refer to the MCO for information about benefits, limitations, prior authorization, reimbursement, and specific claim processing procedures.

Refer to the current Texas Medicaid Provider Procedures Manual, Medicaid Managed Care Handbook subsection 2.7.3, “Managed Care Organization (MCO) Clients Who Transition to Medicaid Fee-For Service (FFS),” and subsection 2.8, “Authorizations for Managed Care Services,” for more information about the authorization process for managed care services.

Synchronous Audiovisual Visits

Comprehensive visits and follow-up visits completed through the use of synchronous audiovisual technology will be a benefit of Texas Medicaid.

Visits completed using synchronous audiovisual technology or synchronous telephone (audio-only) technology should be provided only if agreed to by the client or parent/guardian.

Note: Information about policy restrictions for services delivered by synchronous telephone (audio-only) technologies will be published in the September 2022 Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook.

Procedure Codes and Modifiers

Case management for children and pregnant women services must be submitted with procedure code G9012 and the following modifiers:


Required Modifiers

Comprehensive visit (in-person)

U2 and U5

Comprehensive visit (synchronous audiovisual)

U2, U5, and 95

Follow-up visit (in-person)

U5 and TS

Follow-up visit (synchronous audiovisual)

U5, TS, and 95

Follow-up visit telephone (audio-only)

TS and 93

On September 1, 2022, additional case management for children and pregnant women benefit language will be published in the Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook.

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