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Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective June 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.

Reimbursement rate changes and updates for some ambulatory surgical center procedure codes that were presented at a public rate hearing on November 7, 2022, will be implemented on June 1, 2023.

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

The following topics were covered at the public rate hearing:

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