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Several Static Fee Schedules to Be Updated

Last updated on

On the Texas Medicaid & Healthcare Partnership (TMHP) will update several static fee schedules to align them with the standardized format of the schedules that are published on the Static Fee Schedule page.

The following static fee schedules will be updated:

File NameCurrent Fee Schedule NameNew File NameNew Fee Schedule Name
PRCR430C_IRenal Dialysis Facility - InsertPRCR430IRenal Dialysis Facility Composite Rates
PRCR417C_INephrology (Hemodialysis, Renal Dialysis) - InsertPRCR417INephrology (Hemodialysis, Renal Dialysis) Composite Rates
PRCR453CIndian Health ServicesPRCR453CIndian Health Services
PRCR604CHospital Outpatient Imaging ServicesPRCR604CHospital Outpatient Imaging Services
PRCR494C_IClinical Laboratory, Automated Test Panels (Insert)PRCR494IClinical Diagnostic Laboratory

The PRCR430I Renal Dialysis Facility Composite Rates and PRCR417I Nephrology (Hemodialysis, Renal Dialysis) Composite Rates files contain lines with $0.00 rates. The $0.00 rates indicate that the listed service was not a benefit at the time of the date of service that is displayed in the column header.

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.

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