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QW Modifier Update and Claims Reprocessing for Procedure Code 87521

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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 June 27, 2024, procedure code 87521 will require the QW modifier. Claims submitted with procedure code 87521 for dates of service from June 27, 2024, through October 3, 2024, may be reprocessed.

The reprocessed claims may result in additional payment that will be reflected on future Remittance and Status (R&S) Reports.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.