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 October 1, 2023, Texas Medicaid will cover the following additional indications for hospital-grade blood pressure devices:
- Pulmonary embolism
- Stenosis of either coronary artery stent or peripheral vascular stent
- Valve disorders
Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, section 220.127.116.11, “Hospital-Grade Blood Pressure Devices,” for more information about hospital-grade blood pressure devices.
For more information, call the TMHP Contact Center at 800-925-9126.