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 July 11, 2023, will be implemented.
The following topics were covered at the public rate hearing:
- Special review for:
For more information, call the TMHP Contact Center at 800-925-9126.