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Reimbursement Rates Implemented for Some Second Quarter HCPCS Drugs Procedure Codes for Medicaid Effective July 1, 2022

Last updated on 7/18/2022

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 July 1, 2022, reimbursement rates for the procedure codes for some 2022 second quarter Healthcare Common Procedure Coding System (HCPCS) drugs were implemented for Texas Medicaid.

The following procedure codes were implemented:

The Texas Medicaid & Healthcare Partnership (TMHP) will automatically reprocess affected claims if any are identified; providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.

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