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Procedure Code(s) Must Now Be Listed on Radiology Prior Authorization Request Form

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The Radiology Prior Authorization Request Form was updated on July 23, 2026, to include Procedure Code(s) in Section B of the form.

On the updated form, providers must include all applicable procedure codes. Authorizations will not be granted if procedure codes are not listed on the form.

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.