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2025 TMPPM Release Notes

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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 2024, see the 2024 Release Notes.

For changes that were made in 2024, see the 2024 Release Notes

May 2025 TMPPM Release Notes
HandbookRelated Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities

Removed "Medicaid" and added "Program" to Vendor Drug Program information in section 1.11.

Removed tuberculosis from bulleted list in section 1.11.

Volume 1: Section 2: Texas Medicaid Fee-for-Service ReimbursementMade updates to sections 2.2.1.3 and 2.2.2 to update Vendor Drug Program information.
Volume 1: Appendix A: State, Federal, and TMHP Contact InformationUpdated Vendor Drug Program information throughout handbook.
Volume 1: Appendix C: Acronym DictionaryRemoved acronyms no longer found in the manual; updated acronyms based on new information in manual; added new acronyms that are found in the manual.
Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Clarification of Wheeled Mobility System Benefit Information in the TMPPM

Information posted March 14, 2025

Healthy Texas Women (HTW) Program Handbook

Influenza Vaccine Procedure Code 90661 a Benefit for HTW Effective March 1, 2025

Information posted April 10, 2025

Outpatient Drug Services Handbook

First Quarter 2025 HCPCS Updates for Texas Medicaid

Information posted April 11, 2025

Update to “Sickle Cell Disease Gene Therapy Coverage Information”

Information posted April 23, 2025

Prior Authorization Updates for Esketamine (Spravato) Effective May 1, 2025, for Texas Medicaid

Information posted March 14, 2025

Email changed for Program Policy and Management in section 1.3, "Program Contact Information." Webpage links updated in subsections 8.5.4.1.2, "Obtaining Products," 8.5.4.1.3, "Returning Products," and 8.5.4.2.3, "Returning Products."

Prior Authorization Criteria for Afamitresgene Autoleucel (Tecelra) Effective May 1, 2025

Information posted April 11, 2025

April 2025 TMPPM Release Notes
HandbookRelated Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities

Updated information for individual provider type enrollment in section 1.1.4.

Added clarifying language for dual participating providers to section 1.1.9.4.

Volume 1: Section 4: Client Eligibility

Replaced phone number with email address for Lock-In program.

Updated organization title in section 4.1.7.

Behavioral Health and Case Management Services HandbookReplaced incorrect acronym with correct acronym for Board of Nursing.
Children’s Services Handbook: Medical services (Sections 1-2 and 4-8)

TMPPM Update for OEFV Services

Information posted February 28, 2025

Update to a Prior Authorization Requirement for Autism Services Effective April 1, 2025

Information posted February 14, 2025

Medical and Nursing Specialists, Physicians, and Physician Assistants HandbookRemoved text from section title "Not Including Labor and Delivery," in section 9.2.53.2, "Epidural and Subarachnoid Infusion (Not Including Labor and Delivery)."
Outpatient Drug Services Handbook

Corrected acronym for hematopoietic stem cell transplant in section 6.42, "Emapalumab-lzsg (Gamifant)."

In section 11.1, "Clinical Prior Authorization," revised form name to match the title on the Texas Department of Insurance form.

In subsection 8.7.2.1, "Managed Care," revised form name to match the title on the Texas Department of Insurance form, and removed extra letter in form number.

School Health and Related Services (SHARS) Handbook

Added reimbursement statement for Personal Care Services to section 2.3.4.2, "Activities Eligible for PCS," to align with SHARS medical policy.

Updated note statement in section 2.4.1, "Record Retention," to include PCS provider and supporting document information to align with SHARS medical policy.

March 2025 TMPPM Release Notes
HandbookRelated Articles and Notes
Behavioral Health and Case Management Services Handbook

CoCM Services Provided by FQHC and RHC Providers

Information posted January 10, 2025

Certified Family Partner Services to Become a Benefit of Texas Medicaid on March 1, 2025

Information posted January 10, 2025

Children’s Services Handbook: Appendix B: ImmunizationsRemoved adult vaccine procedure codes from the Vaccines table as this handbook is designated for clients who are under the age of 21. The adult vaccine codes currently are listed in the Medical and Nursing Specialists, Physicians, and Physician Assistants handbook.
Children’s Services Handbook: Medical services (Sections 1-2 and 4-8)Removed adult vaccine procedure codes from the Vaccines table as this handbook is designated for clients who are under the age of 21. The adult vaccine codes currently are listed in the Medical and Nursing Specialists, Physicians, and Physician Assistants handbook.
Children’s Services Handbook: THSteps Dental services (Section 3)

Changes to Texas Health Steps Dental Services Effective March 1, 2025

Information posted January 10, 2025

Clinics and Other Outpatient Facility Services Handbook

Changes to Texas Health Steps Dental Services Effective March 1, 2025

Information posted January 10, 2025

Durable Medical Equipment, Medical Supplies, and Nutritional Products HandbookUpdated exceptional circumstances language in section 2.2.23. Policy updated to remove the broken link to the Exceptional Circumstances for Durable Medical Equipment and Supplies policy, leaving only language referring to the Exceptional Circumstances process.
Healthy Texas Women (HTW) Program HandbookRemoved procedure code J2510 from section 2.3 as it is being made not a benefit for Texas Medicaid.
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Home Sleep Study Test Procedure Code 95800 to Become a Benefit Effective March 1, 2025

Information posted December 27, 2024

CoCM Services Provided by FQHC and RHC Providers

Information posted January 10, 2025

Removed procedure code J2510 from the table of section 9.4.2.1, “Additional Payable Procedure Codes,” as this code is no longer a benefit.

Outpatient Drug Services Handbook

Corrected typo for procedure codes listed in section 6.6, "Alzheimer’s Disease (AD)." Procedure code J0175 is drug name Donanemab-azbt (Kisunla) and procedure code J0174 is drug name lecanemab-irmb (Leqembi).

Age Limitation Update for Cerliponase Alfa (Brineura), Procedure Code J0567

Information posted February 14, 2025

Vision and Hearing Services HandbookReplaced URL link for form 3503 to new link.
February 2025 TMPPM Release Notes
HandbookRelated Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities

Deficiency Limit for PEMS Requests Extended to 165 Business Days

Information posted December 16, 2024

Clarified language in section 1.1.9.10.

Provider Enrollment Revalidation Window Extended From 120 to 180 Days

Information posted May 31, 2024

Behavioral Health and Case Management Services HandbookFixed bullets and removed extra words from enrollment language in section 3.2.
Children’s Services Handbook: Appendix B: Immunizations

2025 HCPCS Special Bulletin

Information posted December 31, 2024

Children’s Services Handbook: Appendix F: Texas Health Steps Quick Reference Guide

2025 HCPCS Special Bulletin

Information posted December 31, 2024

Children’s Services Handbook: Medical services (Sections 1-2 and 4-8)

2025 HCPCS Special Bulletin

Information posted December 31, 2024

Clinics and Other Outpatient Facility Services Handbook

2025 HCPCS Special Bulletin

Information posted December 31, 2024

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Updated limitations for procedure codes K0010, E0630, and E0635. Updated language in section 2.2.17.26.

Added new nutritional products authorization requirements to section 2.2.18.1.

Added rental limitations to procedure codes E0303 and E0304 in table in section 2.2.14.10.

Healthy Texas Women (HTW) Program Handbook

2025 HCPCS Special Bulletin

Information posted December 31, 2024

Inpatient and Outpatient Hospital Services Handbook

Updates to the TMPPM Inpatient and Outpatient Hospital Services Handbook

Information posted December 6, 2024

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

2025 HCPCS Special Bulletin

Information posted December 31, 2024

Removed discontinued procedure codes 91304, 91318, 91319, and 91321 from the table of section 9.2.36.2, "Vaccine and Toxoid Procedure Codes," and table 9.2.37, "Immunizations for Clients Who Are 21 Years of Age or Older."

Outpatient Drug Services Handbook

Donanemab-azbt (Kisunla) Procedure Code J0175 for Alzheimer’s Disease Therapy a Benefit Effective January 1, 2025

Information posted December 27, 2024

DaxibotulinumtoxinA-lanm (Daxxify Brand Toxin Type A) Injection Procedure Code J0589 to Become a Benefit Effective January 1, 2025

Information posted January 13, 2025

Prior Authorization Criteria for Imetelstat (Rytelo) Effective February 1, 2025

Information posted January 3, 2025

Added procedure codes J0139, Q5140, Q5141, Q5142, Q5143, Q5144, and Q5145 with age restrictions to section 6.2, "Adalimumab."

2025 HCPCS Special Bulletin

Information posted December 31, 2024

Sickle Cell Disease Gene Therapy Coverage Information

Information posted January 10, 2025

Radiology and Laboratory Services Handbook

2025 HCPCS Special Bulletin

Information posted December 31, 2024

Vision and Hearing Services Handbook

2025 HCPCS Special Bulletin

Information posted December 31, 2024

January 2025 TMPPM Release Notes
HandbookRelated Articles and Notes
Volume 1: Section 1: Provider Enrollment and Responsibilities

Providers Must Disclose in PEMS Whether Their Practice Location Is Physically Accessible to People With Disabilities and If Their Practice Has a Website

Information posted November 12, 2024

Volume 1: Section 6: Claims Filing

Electronic Submission Option for MAP Crossover Claims to Be Available December 9, 2024

Information posted November 25, 2024

Updates to Medicare Crossover Claim Co-Payments Effective December 6, 2024

Information posted October 21, 2024

Updated the claims filing calendar and the filing deadline calendar links for 2025.

Children’s Services Handbook: Appendix B: Immunizations

Age Range Updates for Trivalent Influenza Vaccine Procedure Codes Effective September 1, 2024

Information posted December 12, 2024

Children’s Services Handbook: Medical Services (Sections 1-2 and 4-8)

Age Range Updates for Trivalent Influenza Vaccine Procedure Codes Effective September 1, 2024

Information posted December 12, 2024

Children’s Services Handbook: THSteps Dental Services (Section 3)

Criteria for Some Texas Health Steps Orthodontic Treatment Services Will Change on January 1, 2025

Information posted November 15, 2024

Clinics and Other Outpatient Facility Services Handbook

Updates to Medicare Crossover Claim Co-Payments Effective December 6, 2024

Information posted October 21, 2024

Reimbursement Updates for Certain Renal Dialysis Drugs Effective January 1, 2025

Information posted December 30, 2024

Durable Medical Equipment, Medical Supplies, and Nutritional Products HandbookUpdated spelling of non-warranty in section 2.2.5.1.2.
Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Age Range Updates for Trivalent Influenza Vaccine Procedure Codes Effective September 1, 2024

Information posted December 12, 2024

Biomarker Testing Noncovered Services Language to Be Updated in TMPPM

Information posted November 27, 2024

Outpatient Drug Services Handbook

Update to TMPPM Outpatient Drug Services Handbook Effective January 1, 2025

Information posted December 20, 2024