The following tables show the section and handbooks that were changed in the Texas Medicaid Provider Procedures Manual. The changes are listed in reverse chronological order (newest first).
For changes that were made in 2020, see the 2020 Release Notes.
December TMPPM Release Notes | |
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Handbook |
Related Articles and Notes |
In section 6.1, replaced old form title with H3017, "Individual Transportation Participant"; Update to align with MTP Form. |
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Changed bullets in section 7.3.1.4 about 24-month payment deadline exceptions, to align with TAC Rule 354.1003. |
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In section 5.1.2, replaced DSHS phone number with performance.contracts@hhsc.state.tx.us email address. Replaced DSHS with HHSC. |
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Revised the edition number for Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Added handbook section reference to section 4.3.8, "Medical Checkup Follow-up Visit." |
Revised physician E/M statement and added handbook section reference to section 8.2.1, "TB-Related Clinic Services." |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Removed section 2.2.12.8, "Tubeless External Insulin Infusion Pumps," and all of the subsections within that section. |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Added "refer to" in section 4.1.14, "Antenatal and Postnatal Care Visits." |
Universal Mean Change on October 1, 2021 Information posted October 28, 2021 |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Added "bladder stones" to surgical therapy statement in section 9.2.59.1.2, "Types of Laser Procedures." Established E/M limitation statements updated in sections 9.2.56.1.1, "New and Established Patient Services," 9.2.56.6, "Domiciliary, Rest Home, or Custodial Care Services," and 9.2.56.7, "Home Services." |
Prior Authorization for Monoclonal Antibody Therapy to Change Effective December 1, 2021 Information posted November 19, 2021 Prior Authorization Criteria for CAR T-Cell Therapy to Change Effective December 1, 2021 Information posted October 22, 2021 Updated broken links in sections 9.4.4.1.3, "Returning Products" and 9.4.4.2.3, "Returning Products." Removed VDP Pharmacy Provider Procedure Manual link from sections 11.3, "Cost Avoidance Coordination of Benefits," and 12.5, "72-Hour Emergency Supply." Added new section about education and training offered through HHSC and TMHP, and also added new section about prior authorization reconsideration for Managed Care and Medicaid. |
October TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Update to Inpatient Psychiatric Services Benefit Language Effective October 1, 2021 |
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Volume 1: Appendix A: State, Federal, and TMHP Contact Information |
Update to Inpatient Psychiatric Services Benefit Language Effective October 1, 2021 |
Update to Inpatient Psychiatric Services Benefit Language Effective October 1, 2021 |
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Update to Inpatient Psychiatric Services Benefit Language Effective October 1, 2021 |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Benefit Limitation Updates Effective October 1, 2021 |
Home Health Nursing and Private Duty Nursing Services Handbook |
Updated claim form names in section 6.1.2, "PDN Providers." |
Update to Inpatient Psychiatric Services Benefit Language Effective October 1, 2021 |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Effective October 1, 2021, Prostate Procedures for Benign Prostatic Hyperplasia Benefit Criteria to Change Benefit Limitation Updates Effective October 1, 2021 Updated reimbursement statement and added reference to the Inpatient and Outpatient Hospital Services Handbook in subsection 9.2.5.1.2, "Limitations of Allergy Immunotherapy." |
Removed procedure code J0220 from section 7.4, "Alglucosidase Alfa (Myozyme)." |
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Revised the dollar amount in section 4.3.7.6 Repair of Eyeglasses from $2,00 to $2.00 and corrected procedure code 90272 to 92072 in section 4.3.8.3 Contact Fitting for Corneal Bandage Lens. |
August 2021 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Second Quarter 2021 HCPCS Updates for Texas Medicaid |
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Children’s Services Handbook: Appendix F: THSteps Quick Reference Guide |
Second Quarter 2021 HCPCS Updates for Texas Medicaid |
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Second Quarter 2021 HCPCS Updates for Texas Medicaid Updated limitation language for some procedure codes within section 2.5.1.1.9, "Non-Face-to-Face Care Plan Oversight." |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Second Quarter 2021 HCPCS Updates for Texas Medicaid Updated limitation language for panniculectomy and abdominoplasty prior authorization. Changed the word "same" to "any" in the statement below the table of section 9.2.49, "Osteopathic Manipulative Treatment (OMT)." Edits made to statements, procedure code 29799 added to table, and some statements and tables removed from section 9.2.18, "Casting, Splinting, and Strapping." |
Second Quarter 2021 HCPCS Updates for Texas Medicaid Removed duplicate information from section 1.1, "About the Vendor Drug Program." Edits made to statements in section 1.2, "Pharmacy Enrollment," 9.2, "Vitamin and Mineral Products," and 11.6 "Free Delivery of Medicaid Prescriptions." Added subheader to 9.1, "Formulary Search." Edits and additional language about Makena added to section 9.4.4.4, "Makena." In section 9.5.1, "Schedule and Forms" header title, edits and new section added with information about forms for Medicaid and Managed Care. |
July 2021 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Children’s Services Handbook: THSteps Dental services (Section 4) |
TMPPM Children’s Services Handbook Update for Texas Health Steps Dental Services |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
TMPPM Updates for Obstetric Services Effective July 1, 2021 |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
TMPPM Updates for Obstetric Services Effective July 1, 2021 Removed procedure code J2810 from the table in section 9.3.2.1, "Additional Payable Procedure Codes," under the column "Injections/Medications." |
Additional Diagnosis Code Added for Procedure Code J0585 |
June 2021 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Updated facility enrollment instructions to align with PEP instructions. |
Healthy Texas Women Medicaid 1115 Demonstration Waiver Effective March 20, 2021 |
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Children’s Services Handbook: Appendix F: THSteps Quick Reference Guide |
Developmental Screening and Mental Health Screening Tools Added for Texas Health Steps Updated webpage links under the following columns: Texas Health Steps Website, Case Management for Children and Pregnant Women, and Medical Transportation Program (MTP). |
Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Changed DSHS to HHSC in the last statement of section 5.3.10, THSteps Medical Checkups Periodicity Schedule. Developmental Screening and Mental Health Screening Tools Added for Texas Health Steps |
Children’s Services Handbook: THSteps Dental services (Section 4) |
Changed radiograph requirement limitation for procedure code D7962 from PXR to PHO in the table of section 4.2.20, "Oral and Maxillofacial Surgery Services." Update to 2021 HCPCS Bulletin and TMPPM for Texas Health Steps Dental Procedure Codes D7961 and D7962 Added removable prosthodontic procedure codes that require prior authorization to the bulleted list in section 4.2.29, "Mandatory Prior Authorization." |
New HTW Provider Certification Requirements |
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First Quarter 2021 HCPCS Updates for Texas Medicaid Prior Authorization Criteria Updated for Omalizumab (Xolair) Effective June 1, 2021 Ferric Derisomaltose a Benefit of Texas Medicaid Effective April 1, 2021 Indications for Abatacept (Orencia) to Change for Texas Medicaid June 1, 2021 Pegfilgrastim-apgf (Nyvepria) a Benefit of Texas Medicaid Effective April 1, 2021 |
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Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook |
Added a reference in section 7.1 referring to section 2.8 for additional information for home health agencies. |
May 2021 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Updated broken vendor drug links in sections 6.3.4.1 and 6.3.4.2. Added language regarding drug rebates to section 6.3.4.3, "Drug Rebate Program." |
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Children’s Services Handbook: THSteps Dental services (Section 4) |
In section 4.2.12, “Periodicity for THSteps Dental Services,” revised periodicity schedule name to align with the American Academy of Pediatric Dentistry (AAPD) name change. Updated broken website link in Section 4, “Texas Health Steps (THSteps) Dental.” |
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Update to TMPPM for Respiratory Equipment for Clients Not Meeting Required Criteria Listed out all replacement battery procedure codes in section 2.2.12.6, "External Insulin Pump and Supplies," and related supply procedure codes in section 2.2.23.8, "Continuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RAD) including Bi-Level PAP." |
Prior Authorization Criteria for Onasemnogene Abeparvovec-xioi (Zolgensma) will be Updated for Texas Medicaid Effective May 1, 2021 Removed procedure code J1560 from the table of section 7.38, "Immune Globulin." |
April 2021 Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Revised provider enrollment instructions for online and paper applications in sections 1.1.3, "Enrollment," and 1.1.4, "Paper Application Enrollment." |
Updated the express mail only address in section 7.3.3, "Utilization Review Appeals." New TMHP Contact Page Feature for Submitting Complaints in 2021 |
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Removed procedure code 90650 from the table in appendix B.3.3, "Immunizations (Vaccines/Toxoids)." |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Removed procedure code 90650 from the table in section 5.3.11.3, "Immunizations." |
Removed procedure code J1840 from the table of section 8.2.2, "Ancillary Services." |
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Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Removed the phone method for prior authorization requests from the language in section 4.1.8, "Obstetrics Ultrasound." |
Removed procedure code 90650 from section 2.3, "Services, Benefits, Limitations, and Prior Authorization." |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Removed procedure codes J0715, J1840, and J1850 in the table of section 9.3.2.1, "Additional Payable Procedure Codes." Removed procedure code 90650 from the tables of sections 9.2.34.1, "Administration Fee," 9.2.35.2, "Vaccine and Toxoid Procedure Codes," and 9.2.36, "Immunizations for Clients Who Are 21 Years of Age and Older." |
NDC example statement added to section 6, National Drug Code (NDC). Revised the list for detailed filter searches, and added information about the Epocrates drug information system in section 9.1, “Formulary Search.” Updated website information for VDP Product Searches in section 9.2, “Vitamin and Mineral Products,” and section 9.3, “Home Health Supplies.” Updated website information, removed reference statements related to LARC, and VDP Formulary Search. Removed "Formulary" from statement "To identify drugs that require 90 percent utilization, refer to the VDP Formulary Search and select the “90% Utilization” filter. The returned results will include only those drugs that meet this requirement," in section 10.4, “Requirements for Early Refills.” Updated age restrictions for procedure code J1303 in section 7.62, "Ravulizumab-cwvz (Ultomiris)." Removed procedure code J9212 and some minor edits and revisions within section 7.43, "Interferon." |
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Telemonitoring Benefits to Change for Texas Medicaid March 1, 2021 |
February 2021 Release Notes |
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Handbook |
Related Articles and Notes |
Added prior authorization language to section 5.4, "Submitting Prior Authorization Forms." |
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Added language regarding ambulance provider claims to section 2.4.3, "Medicare and Medicaid Coverage." |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
2021 HCPCS Special Bulletin |
Children’s Services Handbook: THSteps Dental services (Section 4) |
2021 HCPCS Special Bulletin Updated statement in section 4.2.5, Children’s Medicaid Dental Plan Choices to clarify the number of dental MCOs. Removed statement about direct and indirect pulp caps from section 4.2.3.9, "Therapeutic Services." Revised and updated language for direct and indirect pulp caps and removed limitation statement for pulp caps in the table of section 4.2.16, "Endodontics Services." |
2021 HCPCS Special Bulletin |
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Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
2021 HCPCS Special Bulletin Added note statement about 42 day global period to section 4.1.14, "Antenatal and Postnatal Care Visits." |
2021 HCPCS Special Bulletin |
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2021 HCPCS Special Bulletin |
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Added prior authorization language to section 2.8, "Authorizations for Managed Care Services."
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
2021 HCPCS Special Bulletin Added note statement about 42 day global period to section 9.2.69.6, "Global Fees." |
2021 HCPCS Special Bulletin Prior Authorization Criteria for Mepolizumab (Nucala) to be Updated for Texas Medicaid Effective February 1, 2021 Update to TMPPM Outpatient Drug Services Handbook for Blood Factor Products |
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2021 HCPCS Special Bulletin |
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2021 HCPCS Special Bulletin |
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2021 HCPCS Special Bulletin |
January 2021 Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Added clinical trial information to section 1.12, "Texas Medicaid Limitations and Exclusions." Replaced TMHP website with HHS website to direct providers to the Provider Marketing Guidelines. |
Balance Billing QMB and MQMB Clients New Section for SHARS in R&S Reports Updated filing deadline calendars throughout section 6. |
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Children’s Services Handbook: THSteps Dental services (Section 4) |
Changed word "panorex" to "panoramic" in the limitation section for procedure code D0330 section 4.2.3.7, "Diagnostic Services." Removed statement, "All fees for tooth restorations include local anesthesia and pulp protective media, where indicated, without additional charges. These services are considered part of the restoration" in section 4.2.3.9, "Therapeutic Services." |
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Update to the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook Added procedure code E1012 to the table in section 2.2.17.30, "Procedure Codes and Limitations for Mobility Aids." |
Added reference to HHS website for more information on Potentially Preventive Events (PPE). |
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Prior Authorization Criteria for Esketamine (Spravato) to be Updated for Texas Medicaid Effective January 1, 2021 |