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Reimbursement Rate Updates for Certain First Quarter 2023 HCPCS Drug Procedure Codes Effective April 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 April 1, 2023, reimbursement rate updates for first quarter 2023 Healthcare Common Procedure Coding System (HCPCS) procedure codes will be implemented for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

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.

Providers can view the following items for more information:

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