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Procedure Code 90846 Reimbursement Rate Has Been Updated for FQHCs

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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 April 13, 2023, for dates of service on or after July 1, 2017, the reimbursement rate for procedure code 90846 was updated for federally qualified health centers (FQHCs). Procedure code 90846 is to be reimbursed at the encounter rate for FQHCs.

Claims with procedure code 90846 that were submitted by FQHCs for dates of service from July 1, 2017, through April 13, 2023, may have been processed as informational-only or reimbursed at an incorrect rate. These claims were submitted for Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program.

Affected claims submitted with dates of service from June 13, 2021, through April 13, 2023, may be reprocessed. When the claims are reprocessed, providers may receive additional payment, which will be reflected on Remittance and Status (R&S) Reports.

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