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TMPPM Update for OEFV Services

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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.

On April 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update language in the Texas Medicaid Provider Procedures Manual (TMPPM), Children’s Services Handbook, subsection 4.3.13.1, “Oral Evaluation and Fluoride Varnish (OEFV) in the Medical Home,” to clarify the following requirements:

  • OEFV is limited to Texas Health Steps medical checkup providers who have completed the required benefit education and are certified by the Texas Health Steps Dental Program to perform OEFV services.
  • The primary care provider must complete the intermediate oral evaluation but can delegate all other components.

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