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Updates to the TMPPM Inpatient and Outpatient Hospital Services Handbook

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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.

The Texas Medicaid Provider Procedures Manual (TMPPM), Inpatient and Outpatient Hospital Services Handbook, section 4.2.2, “Emergency Department Services,” will be updated on February 1, 2025. The following statement will be removed from the handbook to align with existing Texas Medicaid reimbursement policy:

          The administration of an injection may be reimbursed to the provider who administers the injection.

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