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Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective July 26, 2022, and March 1, 2023

Last updated on 2/17/2023

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 July 26, 2022, and effective for dates of service on or after March 1, 2023, reimbursement rate changes and updates for procedure codes presented at a public rate hearing on November 7, 2022, will be implemented.

Effective for Dates of Service On or After July 26, 2022

The following topic was covered at the public rate hearing: Healthcare Common Procedure Coding System (HCPCS) for Procedure Code 87593 Monkeypox.

Note: The Texas Medicaid & Healthcare Partnership (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.

Effective for Dates of Service On or After March 1, 2023

The following topics were covered at the public rate hearing.

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