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Update to New Provider Type for Local Health Departments

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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.

This is an update to an article titled, “New Provider Type for Local Health Departments Effective December 31, 2022,” which was posted on the TMHP website on December 22, 2022.

All current providers enrolled in Medicaid that qualify for local health department (LHD) services now have the option to enroll as an LHD.

LHD Procedure Codes

Beginning April 14, 2023, LHD providers will be added as a payable provider type for the following procedure codes:

11976

11981

11982

11983

58300

58301

71045

71046

71047

74018

80048

82465

83655

80051

80053

80055

80061

80076

80081

81000

81001

81002

81003

81005

81025

82040

82247

82248

82565

82947

83036

83718

83721

83735

84075

84443

84450

84460

84478

84520

85018

85025

88175

86480

86481

86580

86592

86593

86682

86689

86701

86702

86703

86704

86705

86706

86708

86750

86780

86787

86803

87015

87116

87140

87164

87190

87205

87207

87210

87253

87270

87320

87340

87341

87389

87490

87491

87521

87535

87556

87590

87591

87661

87798

87808

87810

88150

88164

90460

90461

90471

90472

90473

90474

90619

90621

90632

90633

90636

90647

90648

90654

90655

90656

90657

90658

90660

90661

90662

90670

90672

90673

90674

90675

90680

90681

90682

90685

90686

90687

90688

90696

90697

90698

90700

90702

90707

90710

90713

90714

90715

90716

90723

90732

90734

90736

90739

90740

90743

90744

90746

90747

90750

90756

92002

92004

92014

92015

96156

96158

96159

96164

96165

96167

96168

96372

97802

97804

99000

99078

99091

99173

99199

99202

99203

99204

99205

99211

99212

99213

99214

99215

99385

99386

99387

99395

99406

99407

99461

99492

99493

A4267

A4268

A4269

D0120

D0140

D0145

D0150

D0160

D0170

D0180

D0210

D0220

D0230

D0240

D0270

D0272

D0274

D0330

D0340

D0350

D0367

D0460

D0470

D0601

D0602

D0603

D1110

D1120

D1206

D1208

D1310

D1330

D1351

D1352

D1510

D1516

D1517

D1520

D1526

D1527

D1551

D1552

D1553

D1556

D1558

D1575

D2140

D2150

D2160

D2161

D2330

D2331

D2332

D2335

D2390

D2391

D2392

D2393

D2394

D2740

D2750

D2751

D2752

D2791

D2792

D2799

D2920

D2930

D2931

D2932

D2933

D2934

D2940

D2950

D2954

D2971

D2999

D3110

D3120

D3220

D3230

D3240

D3310

D3320

D3330

D3346

D3347

D3348

D3351

D3352

D3353

D3999

D4211

D4277

D4278

D4283

D4285

D4341

D4342

D4355

D4910

D4999

D5110

D5120

D5211

D5212

D5213

D5214

D5410

D5411

D5421

D5422

D5520

D5612

D5630

D5640

D5650

D5660

D5670

D5671

D5720

D5721

D5730

D5731

D5740

D5741

D5750

D5760

D5761

D5820

D5821

D5899

D5992

D5993

D6240

D6549

D6750

D6930

D6999

D7111

D7140

D7210

D7220

D7230

D7250

D7270

D7286

D7510

D7550

D7910

D7961

D7962

D7970

D7971

D7997

D7999

D8050

D8060

D8080

D8210

D8220

D8660

D8670

D8680

D8690

D9110

D9210

D9211

D9212

D9215

D9223

D9230

D9243

D9248

D9310

D9430

D9630

D9910

D9930

D9940

D9944

D9951

D9971

D9974

D9999

G0433

G0475

G0506

G9873

G9874

G9875

G9876

G9877

G9878

G9879

G9880

H0033

J0561

J0696

J1050

J1055

J1580

J3490

J7297

J7298

J7300

J7301

J7307

S4993

S9470

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.