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 August 1, 2022, for dates of service on or after January 1, 2022, durable medical equipment (DME) end-stage renal disease (ESRD) procedure code E1629 for clients receiving dialysis in the home setting will become a benefit for Texas Medicaid. Procedure code E1629 will be excluded from the composite rate and will be paid separately.
Providers must submit revenue code 821 and procedure code E1629 on separate details when submitting the claim.
Procedure code E1629 will be denied if billed without revenue code 821 on the same day, same provider.
Texas Medicaid’s intention is to align with Medicare in making the E1629 procedure code payable in addition to the composite rate effective January 1, 2022, through December 31, 2023.
All new and updated procedure codes and their associated reimbursement rates are proposed benefits, pending the July 2022 rate hearing and approval of expenditures. Providers will be notified when the rates and expenditures are approved.
Any affected claims will be reprocessed. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed. For more information, call the TMHP Contact Center at 800-925-9126.