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Reimbursement Rate Updates for Certain 2023 Annual HCPCS Drug Procedure Codes Effective January 1, 2023

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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.

Effective for dates of service on or after January 1, 2023, the reimbursement rate updates for certain 2023 annual Healthcare Common Procedure Coding System (HCPCS) drug 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 the following: Drug Procedure Codes.

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