This article has been updated. To view the updated information, see “Update to ‘Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective September 1, 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 September 1, 2023, reimbursement rate changes and updates for procedure codes presented at a public rate hearing on May 19, 2023, will be implemented for Texas Medicaid.
The following topics were covered at the public rate hearing:
- Calendar fee review for:
- Any Combination 1-2-I-T
- Diagnostic Radiology (Hospital)
- Diagnostic Radiology (Non-Hospital)
- Diagnostic Radiology (Rural Hospital)
- Medical Nutrition Therapy
- Non-Clinical Laboratory Hospitals
- Non-Clinical Laboratory Rural Hospital
- Non-Clinical Laboratory TOS (5/I/T)
- Physician Administered Drugs Non-OncologyPhysician Administered Drugs Oncology
- Physician Administered Drugs Vaccines & ToxoidsS Codes (TOS 1-2-8)
- S Codes (TOS 9-J-E)
- Telemedicine, Telehealth & Telemonitoring
- Medical policy review for:
- Healthcare Common Procedure Coding System (HCPCS) for:
For more information, call the TMHP Contact Center at 800-925-9126.