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Update to “Clarifications for PDN Effective November 1, 2025, for Texas Medicaid”

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This is an update to the article titled “Clarifications for PDN Effective November 1, 2025, for Texas Medicaid,” which was published on this website on September 11, 2025.

The article stated that providers with existing private duty nursing (PDN) prior authorizations for dates of service that occur on, after, or encompass November 1, 2025, must contact the Texas Medicaid & Healthcare Partnership (TMHP) Prior Authorization department to update prior authorizations for clients who require specialized care.

Updated Information

The clarifications of the PDN prior authorization criteria for specialized care related to the UA modifier that were detailed in the article apply only to prior authorization requests that are submitted to TMHP on or after November 1, 2025.

Providers do not need to update existing prior authorizations for PDN services that were submitted before November 1, 2025. Existing prior authorizations for PDN services will remain in effect, as approved, until the authorization period expires and a new request is submitted.

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

Important: Texas Medicaid managed care organizations (MCOs) must follow all the requirements for Medicaid PDN services that are listed in the Texas Medicaid Provider Procedures Manual (TMPPM), including all prior authorization requirements. Texas Medicaid MCOs must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO.