Skip to main content

Updates to the TMPPM Provider Enrollment and Responsibilities Handbook Available December 1, 2024

Last updated on

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.

The Texas Medicaid Provider Procedure Manual (TMPPM), Provider Enrollment and Responsibilities Handbook, section 1.11, “Texas Medicaid Limitations and Exclusions,” will be updated on December 1, 2024. The following information will be added to the list of services, supplies, procedures, and expenses that are not benefits of Texas Medicaid:

  • Prescription medications and surgical procedures used for the purposes of transitioning biological sex, including sex change operations, except when provided to individuals with a medically verifiable genetic disorder of sex development
  • Procedures and treatments as defined by Chapter 161, Section §161.702 of the Texas Health and Safety Code
  • Procedures, services, supplies, treatments, and prescription medications prohibited by Texas state law

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