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Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective January 1, 2024, and 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 January 1, 2024, and September 1, 2024, reimbursement rate changes and updates for procedure codes that were presented at a public rate hearing on May 21, 2024, will be implemented for Texas Medicaid.

The following topics were covered at the public rate hearing:

Effective for Dates of Service on or After January 1, 2024

The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any affected claims that are identified. Providers are not required to appeal the claims unless they are denied for additional reasons after reprocessing is completed.

Effective for Dates of Service on or After September 1, 2024

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