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.
On November 1, 2022, the Texas Medicaid and Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Children’s Services Handbook section 3.2.21, “Adjunctive General Services,” to add prior authorization language for therapeutic dental procedure codes D9248 and D9612.
Additional services for procedure code D9248 may be considered with prior authorization and documentation of medical necessity.
Prior authorization is required for therapeutic parenteral drug procedure code D9612.
For more information, call the TMHP Contact Center at 800-925-9126.