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 | |
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Handbook | Related 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 Reimbursement | Made 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 Information | Updated Vendor Drug Program information throughout handbook. |
Volume 1: Appendix C: Acronym Dictionary | Removed 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 | |
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Handbook | Related 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 Handbook | Replaced 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 Handbook | Removed 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 | |
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Handbook | Related 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: Immunizations | 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: 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 Handbook | Updated 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 Handbook | Removed 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 Handbook | Replaced URL link for form 3503 to new link. |
February 2025 TMPPM Release Notes | |
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Handbook | Related 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 Handbook | Fixed bullets and removed extra words from enrollment language in section 3.2. |
Children’s Services Handbook: Appendix B: Immunizations | Information posted December 31, 2024 |
Children’s Services Handbook: Appendix F: Texas Health Steps Quick Reference Guide | Information posted December 31, 2024 |
Children’s Services Handbook: Medical services (Sections 1-2 and 4-8) | Information posted December 31, 2024 |
Clinics and Other Outpatient Facility Services Handbook | 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 | 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 | 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 | Information posted December 27, 2024 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." Information posted December 31, 2024 Sickle Cell Disease Gene Therapy Coverage Information Information posted January 10, 2025 |
Radiology and Laboratory Services Handbook | Information posted December 31, 2024 |
Vision and Hearing Services Handbook | Information posted December 31, 2024 |