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 2022, see the 2022 Release Notes.
December 2023 TMPPM Release Notes | |
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Handbook | Related Articles and Notes |
Volume 1: Section 6: Claims Filing | TMHP to Update Place of Service Code 55 Information posted November 2, 2023 |
Ambulance Services Handbook | Updated Guidelines for Treatment-in-Place Ambulance Services Information posted October 13, 2023 |
Behavioral Health and Case Management Services Handbook | Information posted October 13, 2023 |
Children’s Services Handbook: Medical services (Sections 1-2 and 4-8) | TMPPM Language Clarification for Autism Services Effective December 1, 2023 Information posted October 13, 2023 In subsection 4.3.12.6.6, "Required Laboratory Tests Related to Medical Checkups," under Lead Screening and Testing, updated the web address to go directly to the web page where the English and Spanish version of the Form Pb-110, Lead Risk Questionnaire forms are located. Added language related to the requirements for the periodicity schedule to section 4.3.12, "Mandated Components." Updated broken links in section 4.3.12.1.5, "Tuberculosis (TB) Screening." |
Children’s Services Handbook: THSteps Dental services (Section 3) | Benefit for Caries Arresting Medicament to Change for Texas Medicaid Effective December 1, 2023 Information posted October 27, 2023 |
Clinics and Other Outpatient Facility Services Handbook | Removed section 7.2.3.1, "Rural Health Clinic Rendering Telemedicine and Telehealth Services." |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | Language Clarification to Medicaid Benefit of Solid Organ Transplants Effective December 1, 2023 Information posted October 13, 2023 |
Outpatient Drug Services Handbook | Prior Authorization Criteria for Teprotumumab-trbw (Tepezza) Updated Effective December 1, 2023 Information posted October 27, 2023 |
August 2023 TMPPM Release Notes | |
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Handbook | Related Articles and Notes |
Volume 1: Section 8: Third Party Liability (TPL) | Added clarifying language in section 8.3. |
Certified Respiratory Care Practitioner (CRCP) Services Handbook | Replaced form hyperlink to the Special Medical Prior Authorization (SMPA) Request Form in section 3.1.1, "Authorization Requirements." |
Children’s Services Handbook: Appendix C: Lead Screening | Replaced broken links in appendix section C.5, "Lead Poisoning Prevention Educational Materials and Forms." Removed Educator's Brochure form. |
Children’s Services Handbook: Medical services (Sections 1-2 and 4-8) | Replaced broken link in subsection 4.3.12.2.3, "Hearing Screening." Added language to clarify the statement when a provider learns of other insurance coverage in section 4.6.1, "Claims Information." |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook | Updated language in section 4.1.13. Replaced broken link. |
Healthy Texas Women (HTW) Program Handbook | Second Quarter 2023 HCPCS Updates for Texas Medicaid Information posted June 29, 2023 |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | Second Quarter 2023 HCPCS Updates for Texas Medicaid Information posted June 29, 2023 Replaced form hyperlink to the Special Medical Prior Authorization (SMPA) Request Form. |
Outpatient Drug Services Handbook | Update to Outpatient Drug Services Handbook for Hematopoietic Injections Information posted July 21, 2023 Updated statement to remove the City Drugs pharmacy name and address. Second Quarter 2023 HCPCS Updates for Texas Medicaid Information posted June 29, 2023 Updated Prior Authorization Criteria for Monoclonal Antibodies Effective August 1, 2023 Information posted June 23, 2023 Update to TMPPM Outpatient Drug Services Handbook for Colony Stimulating Factors Information posted Diagnosis and Age Restrictions to Change for Hydroxyprogesterone Caproate Procedure Code J1729 Information posted July 21, 2023 Prior Authorization Criteria for Teplizumab-mzwv (Tzield) Effective August 1, 2023 Information posted |
School Health and Related Services (SHARS) Handbook | SHARS Audiology Services Provided Under Section 504 Plans Information posted June 16, 2023 SHARS SLP and Audiology Providers Can Enroll as ORP Providers Effective July 3, 2023 Information posted June 21, 2023 |
Vision and Hearing Services Handbook | Replaced broken link. |
July 2023 TMPPM Release Notes | |
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Handbook | Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities | Removed info about NPI validation grace period from section 1.7.2.2. Updated TMHP address in section 1.2.5. New Medicare-Only Program Enrollment Effective June 30, 2023 Information posted May 16, 2023 |
Volume 1: Section 2: Texas Medicaid Fee-for-Service Reimbursement | New Medicare-Only Program Enrollment Effective June 30, 2023 Information posted May 16, 2023 |
Volume 1: Section 5: Fee-for-Service Prior Authorizations | Updated TMHP address in section 5.5.2.4. |
Volume 1: Section 6: Claims Filing | Updated TMHP address in section 6.11.6. |
Volume 1: Appendix A: State, Federal, and TMHP Contact Information | Updated TMHP address in section A.11. |
Behavioral Health and Case Management Services Handbook | Updated TMHP address in section 9.10.1. Clarification of Documentation Requirements for Psychotherapy Services Information posted May 12, 2023 |
Children’s Services Handbook: Medical services (Sections 1-2 and 4-8) | Removed the limitation language that requires procedure code 99358 to be billed with appropriate physician E/M code for non-face-to-face prolonged services. |
Children’s Services Handbook: THSteps Dental services (Section 3) | Updated TMHP mailroom address in section 3.5.5, "Claim Appeals." |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook | Noninvasive Prenatal Screening Benefits to Change for Texas Medicaid July 1, 2023 Information posted June 16, 2023 |
Inpatient and Outpatient Hospital Services Handbook | Changed TMHP's address in sections 4.2.6, 4.2.11.1, 4.2.19.1, 6.2.9.1, 6.2.12. |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | Requirements for Neurostimulators and Neuromuscular Stimulators Procedure Code A4560 Information posted May 19, 2023 Removed statement with procedure code C9250 as this code is not a Medicaid benefit. Updated TMHP mailroom address in the following sections: 3.2.5, "Prior Authorization," 9.2.12.2, "Prior Authorization," 9.2.12.2, "Prior Authorization for Biofeedback Services," 9.2.13, "Blepharoplasty Procedures," 9.2.15.3.3, "Prior Authorization for Genetic Testing for Colorectal Cancer," 9.2.26.6.1, "Prior Authorization for ECG," 9.2.65.1, "Prior Authorization for Reduction Mammaplasty," 9.2.75.1, "Prior Authorization for Therapeutic Radiopharmaceuticals," and 9.4.1.1, "Guidelines for Requesting Mandatory Prior Authorization." |
Outpatient Drug Services Handbook | Update to Outpatient Drug Services Handbook for Belantamab Mafodontin-blmf (Blenrep) Information posted June 23, 2023 Updated TMHP mailroom address in section 5.1.4, "Nonspecific, Unlisted, or Miscellaneous Procedure Codes." |
June 2023 TMPPM Release Notes | |
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Handbook | Related Articles and Notes |
Volume 1: Section 6: Claims Filing | Updated the Place of Service codes table in section 6.3.1.1 to match the National Place of Service codes. |
Children’s Services Handbook: Appendix C: Lead Screening | Replaced broken links in appendix sections C.3, "Measuring Blood Lead Levels," and C.5, "Lead Poisoning Prevention Educational Materials and Forms." |
Children’s Services Handbook: Appendix E: Hearing Screening Information | Replaced broken hyperlink in appendix section E.1, "Texas Early Hearing Detection and Intervention (TEHDI) Process." |
Children’s Services Handbook: Medical services (Sections 1-2 and 4-8) | TMPPM Update for Health and Behavior Assessment and Intervention Criteria Effective June 1, 2023 Information posted April 14, 2023 Replaced broken links in the following sections and subsections: 4.1, "THSteps Medical and Dental Administrative Information," 4.2.1.1, "Requirements for Registered Nurses Who Provide Medical Checkups," and 4.3.12.2.3, "Hearing Screening." |
Children’s Services Handbook: THSteps Dental services (Section 3) | Information posted April 14, 2023 |
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook | Changed enrollment instructions in section 2.1. |
Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook | Removed section 4.1.12 and its subsections. |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | Information posted April 28, 2023 First Quarter 2023 HCPCS Updates for Texas Medicaid Information posted March 30, 2023 |
Outpatient Drug Services Handbook | Information posted April 21, 2023 HHSC Has Removed Makena Effective April 7, 2023 Information posted April 21, 2023 TMPPM Outpatient Drug Services Handbook Correction for Ravulizumab-cwvz (Ultomiris) Information posted May 12, 2023 Procedure Code J1305 Age Limit To Be Revised Effective June 1, 2023 Information posted April 28, 2023 Update to Outpatient Drug Services Handbook for Hereditary Angioedema (HAE) Agents Information posted May 12, 2023 |
Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook | Updated limitation language in section 6.3.3. Updated speech therapy limitation language in section 5.5.3. |
Vision and Hearing Services Handbook | Updated language for hearing devices in sections 3.2.1, 3.2.1.2, 3.2.2.2, 3.2.3.2. |
May 2023 TMPPM Release Notes | |
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Handbook | Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities | Removed section 1.7.19. |
Volume 1: Section 2: Texas Medicaid Fee-for-Service Reimbursement | Information posted October 26, 2021 |
Volume 1: Section 4: Client Eligibility | Removed TMHP Contact Center and added AIS information. |
Behavioral Health and Case Management Services Handbook | Updated language to be "or" and singular in sections 4.2, 4.2.2, and 4.3.1. Added new CPW PA information to sections 3.3.4, 3.3.4.1, and 3.5. |
Children’s Services Handbook: THSteps Dental services (Section 3) | Update to TMPPM for Some Dental Procedure Codes Effective May 1, 2023 Information posted March 17, 2023 Updated and removed language to align with the Orthodontic Services benefit information. |
Clinics and Other Outpatient Facility Services Handbook | First Quarter 2023 HCPCS Updates for Texas Medicaid Information posted March 30, 2023 |
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook | Added AIS information. |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | Added procedure code 88280 and quantity limitation to the table in section 9.2.40.6, "Cytogenetics Testing." Updated limitation statements and removed procedure code 69990 for Posterior Segment of the Eye, Vitreous–Vitrectomy in section 9.2.47.2.1, "Other Eye Surgery Procedures." |
Outpatient Drug Services Handbook | First Quarter 2023 HCPCS Updates for Texas Medicaid Information posted March 30, 2023 |
Vision and Hearing Services Handbook | TMPPM Update for Hearing Aid Services Prior Authorization Language Information posted March 17, 2023 Removed diagnosis codes from table in section 4.3.6.3; updated TAC language in section 4.3.7. |
April 2023 TMPPM Release Notes | |
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Handbook | Related Articles and Notes |
Volume 1: Section 1: Provider Enrollment and Responsibilities | Updated Surety Bond request information in section 1.1.6. Updated link in section 1.1.9.5. Update to New Provider Type for Local Health Departments Information posted March 1, 2023 |
Volume 1: Section 4: Client Eligibility | Updated link in section 4.4.4. |
Behavioral Health and Case Management Services Handbook | Removed extra language from section 6.5. Updated links throughout CPW sections to be correct. |
Children’s Services Handbook: Medical services (Sections 1-2 and 4-8) | Clarification Language for Autism Services Effective April 1, 2023 Information posted February 10, 2023 |
Children’s Services Handbook: THSteps Dental services (Section 3) | Update to TMPPM and CSHCN Services Program Provider Manual for Dental Procedure Code D2910 Information posted February 10, 2023 |
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | In the procedure code table of section 9.2.40.6, "Cytogenetics Testing," changed the quantity allowed limitation for procedure code 88273 from 10 per day to 3 per day. |
Vision and Hearing Services Handbook | Added sentence clarifying soft headband BAHD processor for clients five years of age and older, and corrected typo in section 3.2.3.2. Replaced link in section 2.2.2.1. |
March 2023 TMPPM Release Notes | |
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Handbook | Related Articles and Notes |
Clinics and Other Outpatient Facility Services Handbook | Removed procedure code Q0139 from the table of section 6.2.2, "Renal Dialysis Facilities-Consolidated Billing." |