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Updates to Joint Injections and Trigger Point Injections Benefit Criteria Effective November 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.

Effective for dates of service on or after November 1, 2025, Texas Medicaid will change benefit criteria for joint injections and trigger point injections.

Injectable medication and the administration of medications through the intramuscular (IM), subcutaneous (SQ), or intravenous (IV) route are a benefit of Texas Medicaid.

Viscosupplementation agents include hyaluronic acid, which is injected into the knee joint to relieve pain associated with osteoarthritis.

Providers must use the following viscosupplement procedure codes to submit claims for osteoarthritis of the knee:

Viscosupplement Procedure Codes
J3470J3471J3472J3473J7318J7320J7321J7322J7323J7324
J7325J7326J7328J7329      

If a provider submits a claim for an administration code with one of the viscosupplement procedure codes without a qualifying diagnosis code, Texas Medicaid will deny the claim.

Texas Medicaid may reimburse claims for viscosupplement procedure codes that are submitted with the following approved diagnosis codes:

Diagnosis Codes
M170M1710M1711M1712M172M1730M1731M1732
M174M175M179     

Trigger Point Injections

Joint injections and trigger point injections are valid only in the treatment of acute problems or the exacerbation of a chronic condition. The provider must use the AT modifier to indicate an acute condition and use modifiers LT (left) or RT (right) as appropriate.

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