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Reimbursement Rate Updates for Drug Procedure Code Q0224 Applicable From March 22, 2024, Through September 30, 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 September 17, 2024, for dates of service on or after March 22, 2024, through September 30, 2024, reimbursement rate updates for drug procedure code Q0224 were implemented for Texas Medicaid.

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.

To view the updates, see the Drug Procedure Code Q0224 spreadsheet.

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