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.
Beginning November 10, 2022, for dates of service on or after October 1, 2022, reimbursement rate updates for third quarter 2022 Healthcare Common Procedure Coding System (HCPCS) procedure codes will be implemented for Texas Medicaid.
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.
To view the updates, click the following link: Third Quarter 2022 HCPCS Drugs
For more information, call the TMHP Contact Center at 800-925-9126.