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Provider Type and Places of Service Update for Procedure Code 96372 Effective January 1, 2024

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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.

Effective for dates of service on or after January 1, 2024, injectable medication administration procedure code 96372 may be reimbursed to Texas Health Steps medical providers for services rendered in the office, outpatient hospital, and birthing center settings.

Reprocessing

Affected claims that are submitted with dates of service on or after January 1, 2024, will be reprocessed. Providers may receive additional payment, which will be reflected on future Remittance and Status (R&S) Reports.

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