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, the reimbursement rates for drugs procedure codes C9096 and J9304 will be implemented for Texas Medicaid.
To view the updates, click the following link: Drugs
Any affected claims that are identified 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.