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New and Updated Taxonomy Codes for Some Medicaid and CSHCN Services Program Providers Effective April 1, 2023

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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 April 1, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will add some new taxonomy codes associated with pharmacy providers rendering specific services. In addition, the definitions of some taxonomy codes associated with allopathic and osteopathic physicians, physician assistants, and advanced practice nursing providers will be updated. The new taxonomy codes and updates apply to Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

New Taxonomy Codes

The following taxonomy codes will be added for pharmacy service providers:

Provider Type

Taxonomy Code

Pharmacist: Cardiology

1835C0206X – A licensed pharmacist who has demonstrated specialized knowledge and skill in direct patient care to ensure safe and effective use of medications in patients with cardiovascular disease, as members of interprofessional health care teams

Pharmacist: Compounded Sterile Preparations

1835C0207X – A licensed pharmacist who has demonstrated specialized knowledge and skill to ensure that sterile preparations meet the clinical needs of patients, satisfying quality, safety, and environmental control requirements, regulations, and standards in all phases of preparation, storage, transportation, and administration

Pharmacist: Emergency Medicine

1835E0208X – A licensed pharmacist who has demonstrated specialized knowledge and skill in the care for patients at the bedside in emergency medicine settings

Pharmacist: Infectious Diseases

1835I0206X – A licensed pharmacist who has demonstrated specialized knowledge and skill in the use of microbiology and pharmacology to develop, implement, and monitor drug regimens that incorporate antimicrobials to optimize therapy for patients

Pharmacist: Solid Organ Transplant

1835S0206X – A licensed pharmacist who has demonstrated specialized knowledge and skill delivering direct patient care and the safe and effective use of medications for patients in all phases of solid organ transplantation

Updated Taxonomy Codes

The following taxonomy code definitions have been updated:

Provider Type

Taxonomy Code

Allopathic & Osteopathic Physicians: Allergy & Immunology, Allergy

207KA0200X – A physician who specializes in the diagnosis, treatment, and management of allergies

Allopathic & Osteopathic Physicians: Allergy & Immunology

207KI0005X – An allergy and immunology physician who specializes in clinical and laboratory immunology disease management

Allopathic & Osteopathic Physicians: General Practice

208D00000X – A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions

Allopathic & Osteopathic Physicians: Neuromusculoskeletal Medicine, Sports Medicine

204C00000X – A Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of sports medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine and integrates each of these into the management of the individual engaged in physical exercise (sports) whether as an individual or in team participation

Allopathic & Osteopathic Physicians: Obstetrics & Gynecology

207VG0400X – A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions

Allopathic & Osteopathic Physicians: Obstetrics & Gynecology

207VX0000X – A physician who specializes in diagnosis, treatment, and management of patients with obstetric conditions

Allopathic & Osteopathic Physicians: Transplant Surgery

204F00000X – A surgeon who specializes in transplant surgery

Physician Assistants & Advanced Practice Nursing Providers: Advanced Practice Midwife

367A00000X – Advanced practice midwifery encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproductive health; gynecologic health; and family planning services, including preconception care. Midwives also provide primary care for individuals from adolescence throughout the lifespan as well as care for the healthy newborn during the first 28 days of life Midwives provide initial and ongoing comprehensive assessment, diagnosis, and treatment. Midwifery care includes health promotion, disease prevention, risk assessment and management, and individualized wellness education and counseling

Providers may refer to the Washington Publishing Company website for complete descriptions of the taxonomy codes.

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