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Correction to “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.

This is a correction to the article titled “Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective January 1, 2024, and September 1, 2024” that was published on this website on August 21, 2024. The original article featured incorrect rates in the Urinary System Surgery and the Physician Administered Drugs – Vaccines & Toxoids spreadsheets. The affected spreadsheets have been updated and now contain the correct procedure codes and reimbursement information.

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.

Use the following links to view all the reimbursement rate changes.

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

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

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