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Third Quarter NCCI Updates Effective July 1, 2025

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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 July 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will implement third quarter National Correct Coding Initiative (NCCI) updates for claims that TMHP processes for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Providers may refer to the Centers for Medicare & Medicaid Services (CMS) Medicaid NCCI web page for updated Medicaid NCCI rules, relationships, and general information. A link to the CMS Medicaid NCCI web page is also available on the Rate and Code Updates – NCCI Updates web page on tmhp.com.

TMHP encourages providers to monitor the CMS website regularly for updates to Medicaid NCCI rules and guidelines.

Anesthesia and Fascial Plane Block Exceptions

Effective for dates of service on or after July 1, 2025, anesthesia procedure codes will be exempt from existing NCCI Procedure-to-Procedure (PTP) editing against procedure codes 64466, 64467, 64468, 64469, 64473, and 64474.

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