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 2021, see the 2021 Release Notes.
December 2022 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Appendix A: State, Federal, and TMHP Contact Information |
Information posted November 12, 2021 |
Information posted November 12, 2021 |
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Information posted November 4, 2022 Prior Authorization Criteria to Change for Crizanlizumab-tmca (Adakveo) Effective December 1, 2022 Information posted October 14, 2022 |
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Clarification for Some SHARS Benefit Information Information posted November 9, 2022 |
November 2022 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
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Reimbursement Rate Updates for Some Texas Medicaid Procedure Codes Effective July 1, 2020 Information posted November 3, 2020
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Reimbursement Rate Updates for Some Texas Medicaid Procedure Codes Effective July 1, 2020 Information posted November 3, 2020
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Children’s Services Handbook: THSteps Dental services (Section 4)
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TMPPM Update for Therapeutic Dental Procedure Codes D9248 and D9612 Information posted September 16, 2022 |
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Third Quarter 2022 HCPCS Updates for Texas Medicaid Information posted September 30, 2022 |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Added date of service language to section 4.1.14. |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Reimbursement Rate Updates for Some Texas Medicaid Procedure Codes Effective July 1, 2020 Information posted November 3, 2020 |
Additional Criteria for Prior Authorization of Onasemnogene Abeparvovec-xioi (Zolgensma) Information posted September 23, 2022 Third Quarter 2022 HCPCS Updates for Texas Medicaid Information posted September 30, 2022 Information posted September 30, 2022 |
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Third Quarter 2022 HCPCS Updates for Texas Medicaid Information posted September 30, 2022
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Moved section Random Moment Time Study (RMTS) after section 2.7.2.5, Quarterly Certification of Funds. Reorganized information within some sections, updated provider type information in some tables, and made minor language revisions to some statements. Changed "school district" to LEA. Added Student Population column to the Audiology procedure code table. Created tables for some statements within the sections Audiology Services, Nursing Services, Occupational Therapy Services, Speech Therapy Services, Personal Care Services, Physical Therapy Services, and Psychological Services. Modifier 93 added to the procedure code table Synchronous Telephone (Audio-Only) Technology. Modifier 95 added to the procedure code table Synchronous Audiovisual Technology. |
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October 2022 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Updated Instructions and Resubmission Guidelines for UB-04 CMS 1450 Paper Claims Information posted July 1, 2022 Removed 1- from phone numbers. |
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TPI Number Removed From Claim Forms, EDI Forms, and Instructions, Effective September 1, 2021 Information posted September 1, 2021 Removed 1- from phone numbers. |
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Fixed typos; Removed 1- from phone numbers. |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Reminder: TMHP Provider Enrollment and Management System (PEMS) Information posted September 7, 2022 |
Reminder: TMHP Provider Enrollment and Management System (PEMS) Information posted September 7, 2022 |
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Removed 1- from phone numbers. Changed language in section 2.1.3.2 to be Service Coordination instead of service management; changed TMHP to MCO in table in section 8. TPI Number Removed From Claim Forms, EDI Forms, and Instructions, Effective September 1, 2021 Information posted September 1, 2021 |
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Update to TMPPM Outpatient Drug Services Handbook October 2022 Information posted September 23, 2022 |
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SHARS Benefits to Change for Texas Medicaid October 1, 2022 Information posted August 12, 2022 |
August 2022 TMPPM Manual Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Information posted April 1, 2022 Reminder: TMHP Provider Enrollment and Management System (PEMS) Information posted March 1, 2022 |
Volume 1: Section 2: Texas Medicaid Fee-for-Service Reimbursement |
Information posted September 1, 2021 |
Information posted September 1, 2021 |
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Information posted September 1, 2021 |
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Information posted September 1, 2021 |
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Volume 1: Appendix A: State, Federal, and TMHP Contact Information |
Information posted September 1, 2021 |
Replaced provider identifier with NPI + taxonomy code in sections 2.1 and 2.4.3.2, replaced provider identifier with NPI in sections 2.4.1 and 2.4.4.2. |
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Information posted September 1, 2021 |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Reminder: TMHP Provider Enrollment and Management System (PEMS) Information posted March 1, 2022 Replaced references to Texas Provider Identifier (TPI) with references to National Provider Identifier (NPI). |
Children’s Services Handbook: THSteps Dental services (Section 4) |
TMPPM Update for Dental Procedure Code D0470 Information posted June 17, 2022 Replaced reference to Texas Provider Identifier (TPI) and provider identifier with a reference to National Provider Identifier (NPI). Added limitation statement to the Limitations section of the table for procedure code D8670. |
End-Stage Renal Disease Procedure Code E1629 to Become a Benefit Information posted July 22, 2022 Replaced reference to Texas Provider Identifier (TPI) and provider identifier with a reference to National Provider Identifier (NPI). |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Prior Authorization Forms are Being Updated Effective September 1, 2021 Information posted August 24, 2021 Updated maximum limit for codes E1050, E1060, E1070, E1100, E1110 in table in section 2.2.17.31. |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Prior Authorization Forms are Being Updated Effective September 1, 2021 Information posted August 24, 2021 |
Reminder: TMHP Provider Enrollment and Management System (PEMS) Information posted March 1, 2022 |
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Home Health Nursing and Private Duty Nursing Services Handbook |
Replaced reference to provider identifier with a reference to National Provider Identifier (NPI). |
Information posted September 1, 2021 |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Information posted September 1, 2021 Replaced references to Texas Provider Identifier (TPI) with references to National Provider Identifier (NPI). |
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Specialist Requirements Removed for Some CADs Effective August 1, 2022 Information posted July 15, 2022 Second Quarter 2022 HCPCS Updates for Texas Medicaid Information posted June 22, 2022 Information posted July 22, 2022 Diagnosis Restriction for Afamelanotide Implant for Texas Medicaid Information posted June 17, 2922 Renumbered some sections and moved the Vitamin and Mineral Products section. Added new section for Mosquito Repellent. Removed the Amifostine section with procedure code J0207. |
Radiology and Laboratory Services Handbook
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Information posted July 20, 2021 |
Replaced reference to Texas Provider Identifier (TPI) with a reference to National Provider Identifier (NPI). |
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Information posted September 1, 2021 |
July 2022 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Added information for CPW taxonomy and removed extra bullet mark in section 1.1.4. |
Moved information from UB 04 CMS 1450 Paper claims instructions block 57 to block 81 in section 6.6.3. |
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Added asterisk to indicate that vaccine procedure code 90756 is administered through TVFC. |
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Children’s Services Handbook: Medical services (Section 1-3 and 5-9) |
Added asterisk to indicate that vaccine procedure code 90756 is administered through TVFC. |
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Limitation Update for Diabetic Equipment and Supplies Procedure Code A4245 Information posted June 17, 2022 |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
Changed VDP website to refer to LARC subsection in 2.2.6.1. |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Corrected typo of last digit for procedure code 67142 and changed 67145 in subsection 9.2.47.2.1, “Other Eye Surgery Procedures.” Removed AT modifier usage language for procedure code 90989. |
Update to TMPPM Outpatient Drug Services Handbook for Ravulizumab-cwvz (Ultomiris) Information posted June 24, 2022 New Treatment Indications for Some CAR T-Cell Infusion Therapies Effective July 1, 2022 Information posted June 3, 2022 Update to Outpatient Drug Services Handbook for Aducanumab-avwa (Aduhelm) Information posted June 17, 2022 Treatment Indications to Change for Ferric Carboxymaltose Effective July 1, 2022 Information posted May 20, 2022 |
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Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook |
TMPPM Update to Physical Therapy, Occupational Therapy, and Speech Therapy Handbook Information posted May 13, 2022 Updated Physical Therapy Group type to Physical/Occupational Therapy Group type. |
June 2022 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Provider Enrollment and Management System (PEMS) Post-Deployment Update Information posted April 25, 2022 |
Provider Enrollment and Management System (PEMS) Post-Deployment Update Information posted April 25, 2022 Added EVV claims filing information to sections 6.1, 6.1.1; Added a new subsection about electronic claims filing for EVV claims to section 6.2. Updated claims filing holiday calendar. |
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The Collaborative Care Model to Become a Benefit of Texas Medicaid June 1, 2022 Information posted April 15, 2022 |
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Children’s Services Handbook: THSteps Dental Services (Section 4) |
Information posted April 15, 2022 |
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Information posted April 15, 2022 |
Added a new table subheader to revenue code table in section 4.5.5 for Pulmonary Function procedure codes 460 and 469. |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
The Collaborative Care Model to Become a Benefit of Texas Medicaid June 1, 2022 Information posted April 15, 2022 |
Updates to the Texas Medicaid Provider Procedure Manual, Outpatient Drug Services Handbook Information posted May 20, 2022 In the table of section 1.3, "Program Contact Information," the contacts and program names were updated. Some sections renumbered and reorganized. New section added for the Clinician-Administered Drug Search and reference was also added to the CAD search on the VDP website. LARC manufacturer name changes made to Merck updated throughout the section. Updated web links in section 11.1.5, "Medicaid Managed Care and CHIP Claims Processing," and section 12.1, "Clinical Prior Authorization." |
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Added new section with patient site language for RHCs, and added RHC to the bulleted list for distant site providers. |
May 2022 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Updates made based on quality review to capture changes from PEMS processes. |
Children’s Services Handbook: THSteps Dental services (Section 4) |
Prior authorization and benefit information language updated in sections 3.2.24.4, “Premature Termination of Comprehensive Orthodontic Treatment," 3.2.29.3.6, “Premature Termination of Orthodontic Services," and 3.2.24.5, "Other Orthodontic Services.” TMPPM Update for Texas Health Steps Restorative Dental Services Information posted March 11, 2022 |
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
TMPPM Update for Hospital Beds and Equipment Procedure Codes E0188 and E0189 Information posted March 11, 2022 |
Added procedure codes C9086 and J0490 to the section 7.59, “Lupus Treatment Agents.” First Quarter 2022 HCPCS Updates for Texas Medicaid Information posted April 1, 2022 Pegfilgrastim-cbqv (Udenyca) to be Diagnosis Restricted Effective May 1, 2022 Information posted April 1, 2022 |
February 2022 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Added new bullet to section 6.1.6 for 2022 Claims Filing Deadline Calendar. |
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Removed Credit Balance Refund Worksheet from forms table in section 7.5. |
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Children’s Services Handbook: Medical services (Sections 1-3 and 5-9) |
Coming Soon: TMHP Provider Enrollment and Management System (PEMS) HHSC Release of Autism Services Benefits Effective February 1, 2022 |
Children’s Services Handbook: THSteps Dental services (Section 4) |
HCPCS Special Bulletin |
HCPCS Special Bulletin In the THSteps Dental Services table, replaced procedure code D8050 with D8010, and D8060 with D8020 in section 4.1.2, "Services, Benefits, Limitations, and Prior Authorization." |
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Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
HCPCS Special Bulletin |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook |
HCPCS Special Bulletin |
HCPCS Special Bulletin |
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Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook |
Coming Soon: TMHP Provider Enrollment and Management System (PEMS) HCPCS Special Bulletin Language related to Asthma Education and Prevention Programs updated to address the new Asthma Management Guidelines. |
Revised and updated language for omalizumab in section 7.55, "Monoclonal Antibodies." HCPCS Special Bulletin Prior Authorization Criteria for Aducanumab-avwa (Aduhelm) Effective February 1, 2022 |
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HCPCS Special Bulletin |
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Coming Soon: TMHP Provider Enrollment and Management System (PEMS) |
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HCPCS Special Bulletin |
January 2022 TMPPM Release Notes |
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Handbook |
Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities |
Coming Soon: TMHP Provider Enrollment and Management System (PEMS) Updated Provider Education information in section 1.9 to align with most recent webpage update and training processes. Replaced webpage info in section 1.7.13 to update invalid link. |
Replaced DSHS with HHSC in section 5.1.2. |
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Children’s Services Handbook: Appendix E: Hearing Screening Information |
Updated broken link and revised the journal name as Journal of Early Hearing Detection and Intervention 2019 Position Statement at "Year 2019 JCIH Position Statement" (usu.edu) in Appendix E.1.3 Evaluation using Texas Pediatric Protocol for Audiology. |
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook |
Changes made to table in section 2.2.12.5. Replaced description for procedure code A9276 to be "30 units*, per 30 days." Added footer at the bottom to add information for asterisk that says "One unit = one-day supply." |
Added procedure codes J2315, Q9991, and Q9992 to the Substance Abuse section in the table in section 2.3.10. |
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Added University of Texas Southwestern Medical Center (UTSW) to section 3.7.4.18. |