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 2023, see the 2023 Release Notes.
| June 2024 TMPPM Release Notes | |
|---|---|
| Handbook | Related Articles and Notes |
| Volume 1: Section 1: Provider Enrollment and Responsibilities | Guidelines for Evaluation and Management Services to Be Updated in the TMPPM Information posted May 31, 2024 |
| Volume 1: Section 4: Client Eligibility | Replaced broken form link with valid link. |
| Children’s Services Handbook: Appendix B: Immunizations | Information posted October 27, 2023 |
| Children’s Services Handbook: Appendix D: Texas Health Steps Statutory State Requirements | Replaced broken links in Appendix section D.4, "Early Childhood Intervention (ECI) Referrals." |
| Children’s Services Handbook: Appendix F: THSteps Quick Reference Guide | Updated Texas Health Steps Quick Reference Guide Available June 1, 2024 Information posted May 31, 2024 Replaced broken links under the Contact Information section. |
| Children’s Services Handbook: Medical services (Sections 1-2 and 4-8) | Replaced broken links in sections 4.3.12.3, "Immunizations," and 4.5.2, "Vaccine Adverse Event Reporting System (VAERS)." Updated website link for the American Academy of Pediatrics Position Statement in subsection 4.3.12.2.3, "Hearing Screening." |
| Clinics and Other Outpatient Facility Services Handbook | Medicare Part B-ID Benefit for ESRD Information posted March 20, 2024 |
| Inpatient and Outpatient Hospital Services Handbook | Changed the modifier in section 6.2.7 to match what is current in policy. |
| Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | Information posted October 27, 2023 Guidelines for Evaluation and Management Services to Be Updated in the TMPPM Information posted May 31, 2024 Replaced broken webpage link in subsection 9.2.36.1, "Vaccine Coverage Through the TVFC Program." |
| Outpatient Drug Services Handbook | Minor grammatical revisions made to some statements within section 6.6.1, "Prior Authorization." Made grammatical updates to statements within sections 6.28, "Chimeric Antigen Receptor (CAR) T-Cell Therapy," and 6.28.2, "Prior Authorization Criteria for Brexucabtagene Autoleucel (Tecartus)." Update to TMPPM Outpatient Drug Services Handbook Effective June 1, 2024 Information posted May 30, 2024 Added procedure code J0174 to diagnosis limitation statement in section 6.6, "Alzheimer's Disease (AD)." Information posted March 18, 2024 |
| Radiology and Laboratory Services Handbook | Added ^ for QW modifier to procedure code 87400 in section 2.2.13. |
| Vision and Hearing Services Handbook | Made grammar edits in section 4.3.6.7. |
| May 2024 TMPPM Release Notes | |
|---|---|
| Handbook | Related Articles and Notes |
| Volume 1: Section 1: Provider Enrollment and Responsibilities | Updated URL in section 1.3.1. |
| Volume 1: Section 4: Client Eligibility | Added outlier payments for hospital claims to section 4.3.1. |
| Behavioral Health and Case Management Services Handbook | First Quarter 2024 HCPCS Updates for Texas Medicaid Information posted April 1, 2024 |
| Children’s Services Handbook: Appendix C: Lead Screening | In appendix section C.1, "Blood Lead Screening Procedures and Follow-up Testing," updated website links and removed 'Group' from the title and replaced with 'Branch' to align with name listed on the Department of State Health Services (DSHS) website. Links also updated in appendix sections C.3, "Measuring Blood Lead Levels," C.4.2, "Documentation Requirements," and C.5, "Lead Poisoning Prevention Educational Materials and Forms." |
| Children’s Services Handbook: Medical services (Sections 1-2 and 4-8) | Under the Lead Screening and Testing subsection removed 'Group' from the title and replaced with 'Branch' to align with name listed on the Department of State Health Services (DSHS) website. |
| Children’s Services Handbook: THSteps Dental services (Section 3) | Added statement "Not payable within 90 days of D4910," to the limitations column for procedure code D4355 in the table of section 3.2.17 Periodontal Services. Removed statement "Not payable within 90 days after D4355," from the limitations column in the table of section 3.2.17 Periodontal Services. |
| Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook | First Quarter 2024 HCPCS Updates for Texas Medicaid Information posted April 1, 2024 Made grammar updates to subsection 2.2.8.2.1. |
| Health and Human Services Commission (HHSC) Family Planning Program Handbook | Updated link in section 2.2. |
| Healthy Texas Women (HTW) Program Handbook | Added language to section 2.1.1 for referrals. First Quarter 2024 HCPCS Updates for Texas Medicaid Information posted April 1, 2024 Information posted April 3, 2024 |
| Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | First Quarter 2024 HCPCS Updates for Texas Medicaid Information posted April 1, 2024 Information posted January 18, 2024 Grammatical updates made to text in subsections 9.2.14.1, "Invasive Bone Growth Stimulation," and 9.2.14.1, "Invasive Bone Growth Stimulation." |
| Outpatient Drug Services Handbook | First Quarter 2024 HCPCS Updates for Texas Medicaid Information posted April 1, 2024 Prior Authorization Criteria for Hormonal Therapy Agents Effective March 1, 2024 Information posted December 15, 2023 Information posted March 29, 2024 Removed duplicate section 6.29, "Ciltacabtagene Autoleucel." The benefit information can be found in section 6.28, "Chimeric Antigen Receptor (CAR) T-Cell Therapy." Adalimumab-aacf (Idacio) Is a Benefit of Texas Medicaid Effective January 1, 2024 Information posted April 11, 2024 Additional Diagnosis Code Allowed for Some Monoclonal Antibodies Effective May 1, 2024 Information posted April 5, 2024 |
| Radiology and Laboratory Services Handbook | Updated the PA Fax and Mail Submission section to change Section 1 to Section A, and Section 2 to Section B per changes made to the forms. Updated the descriptions of Provider Types 22 and 43 to align with the system. Note: Form changes went into effect 04/01/2024.Changed section numbers of Radiology PA form in subsection 3.2.6.2. New Radiology Prior Authorization Form Now Available Information posted April 22, 2024 April 2024 Second Quarter NCCI Updates Information posted March 22, 2024 |
| School Health and Related Services (SHARS) Handbook | SHARS Special Transportation Benefits Will Change on May 1, 2024 Information posted April 26, 2024 |
| March 2024 TMPPM Release Notes | |
|---|---|
| Handbook | Related Articles and Notes |
| Volume 1: Section 1: Provider Enrollment and Responsibilities | Added provider types to Medicare-waiver eligible list in section 1.1.9.10. |
| Volume 1: Section 2: Texas Medicaid Fee-for-Service Reimbursement | Added LMFTs and LPCs to section 2.7.5.1. |
| Volume 1: Section 6: Claims Filing | Updated holiday calendar to include Emancipation Day. Removed language from header row in POS coding table. New National POS 27 and Update to Local POS 2 for Texas Medicaid and CSHCN Claim Systems Information posted February 9, 2024 |
| Behavioral Health and Case Management Services Handbook | Changed footer in table to say "primary codes". Updated the note in Table B from "Psychotherapy add-on code must be billed with an E/M code" to "Psychotherapy add-on code must be billed with the appropriate primary code". Updated language for LMFT and LPC provider types in sections 4.1.5 and 4.1.6. Added plus signs and footer to table; removed note indicating asterisks. |
| Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook | Updates to Diabetic Equipment and Supplies Benefit Information Effective March 1, 2024 Information posted January 12, 2024 |
| Healthy Texas Women (HTW) Program Handbook | Healthy Texas Women Program Benefit Updates Effective March 1, 2024 Information posted February 2, 2024 |
| Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | Removed relationship statement "Procedure code 33947 is denied as part of procedure code 33949 if submitted with the same date of service," in section 9.2.29, "Extracorporeal Membrane Oxygenation (ECMO)." |
| Vision and Hearing Services Handbook | Update to the TMPPM Vision and Hearing Services Handbook Effective March 1, 2024 Information posted February 23, 2024 |
| January 2024 TMPPM Release Notes | |
|---|---|
| Handbook | Related Articles and Notes |
| Volume 1: Section 1: Provider Enrollment and Responsibilities | Changed language in section 1.3 to clarify PE disenrollment process. |
| Volume 1: Section 6: Claims Filing | Updated the 2023 claims filing holiday and deadline information for 2024. Updated language in section 6.4.2.4 to reflect updated PE process. |
| Children’s Services Handbook: THSteps Dental services (Section 3) | Updated statement within section 3.1, "Enrollment," to reflect the appropriate request to be utilized through Provider Enrollment and Management System (PEMS). Removed statements that are no longer valid for the current enrollment process. |
| Clinics and Other Outpatient Facility Services Handbook | Revised statements within section 8.1, "Enrollment," to align with the current enrollment process and indicate the appropriate source that the National Provider identier is issued from as National Plan and Provider Enumeration System (NPPES). |
| Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | Updated statement within section 6.1, "Provider Enrollment," to reflect the appropriate request to be utilized through Provider Enrollment and Management System (PEMS). New Procedure Codes for Diaphragm-Pacing Neuromuscular Stimulation Effective January 1, 2024 Information posted December 15, 2023 Updated statement within section 5.1.1, "Geneticists," to reflect the appropriate assignee of the National Provider Identifier as National Plan and Provider Enumeration System (NPPES). Updated statement within section 3.1, "Provider Enrollment," to reflect the appropriate request to be utilized through Provider Enrollment and Management System (PEMS). |
| Outpatient Drug Services Handbook | Information posted November 27, 2023 |