Skip to main content

Reimbursement Rate Updates for Drug Procedure Codes Effective October 1, 2022

Last updated on

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Beginning January 10, 2023, 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.

TMHP will reprocess any affected claims that are identified. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed.

The updates are available at Third Quarter 2022 HCPCS Drugs Procedure Codes.

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