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.
This is an update to the article titled “Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective September 1, 2023” that was published on this website on July 25, 2023. The update is that the spreadsheet for the Non-Clinical Laboratory TOS (5/I/T) category contained some rows that included “system generated” items in error. The affected spreadsheet has been updated and now features the correct procedure codes and reimbursement information.
To view the updates, review Non-Clinical Laboratory TOS (5/I/T).
For more information, call the TMHP Contact Center at 800-925-9126.