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Updates to the Texas Medicaid Provider Procedures Manual, Inpatient and Outpatient Hospital Services Handbook

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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.

The October 1, 2023, release of the Texas Medicaid Provider Procedures Manual, Inpatient and Outpatient Hospital Services Handbook will include an update to the reimbursement method for ambulatory surgical centers (ASC) and hospital-based ambulatory surgical centers (HASC).

With this update, ASCs and HASCs will no longer be reimbursed according to ambulatory surgical code groupings, but instead will be reimbursed at the rate on the fee schedule. For more information about this update, refer to the article, “Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective June 1, 2023.”

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