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Reimbursement Rate Updates for Syphilis Testing Procedure Code 86593 Effective May 1, 2025, for FPP

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Effective for dates of service on or after May 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the reimbursement rate changes for state-funded Family Planning Program (FPP) syphilis testing procedure code 86593 that were presented at the public rate hearing on November 10, 2025.

Providers can view the updates in the FPP Syphilis Testing procedure code spreadsheet.

Claims Reprocessing

TMHP will identify and reprocess any claims that have been affected by this update. Any adjustments to claims reimbursement amounts will appear on future Remittance and Status (R&S) Reports.

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

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.