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Diagnosis Code Updates for Corneal Pachymetry Effective September 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 September 1, 2024, the following diagnosis code restrictions will be updated for corneal pachymetry (procedure code 76514):

Diagnosis Codes RemovedDiagnosis Codes Added
H1851H18511, H18512, H18513
H1852H18521, H18522, H18523
H1853H18531, H18532, H18533
H1854H18541, H18542, H18543
H1855H18551, H18552, H18553
H1859H18591, H18592, H18593
T86840T868401, T868402, T868403
T84841T868411, T868412, T868413

The one per lifetime limitation for procedure code 76514 will not apply when submitted with the following added diagnosis codes:

Diagnosis Codes
H18511H18512H18513T868401T868402T868403T868411
T868412T868413     

Refer to the current Texas Medicaid Provider Procedures Manual, Vision and Hearing Services Handbook, subsection 4.3.6.2 “Ophthalmic Ultrasound,” for additional information about diagnosis restrictions for procedure code 76514.

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