Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes

Date: February 7, 2025

Attention: All Providers 

Effective dates: January 1, 2024 and September 1, 2024

Call to action: The purpose of this communication is to inform providers that The Texas Medicaid & Healthcare Partnership (TMHP) made a correction to the Urinary System Surgery and the Physician Administered Drugs – Vaccines & Toxoids spreadsheets.The correction can be found in the article Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective January 1, 2024, and September 1, 2024.The affected spreadsheets have been updated and now contain the correct procedure codes and reimbursement information.

Texas Children’s Health Plan (TCHP) will reprocess any impacted claims that are identified. Providers are not required to appeal the claims unless they are denied for additional reasons after reprocessing is completed.

Use the following links to view all the reimbursement rate changes. 

 Effective for Dates of Service on or After January 1, 2024

• Calendar fee review for:
  • Indian Health Services (HIS) Procedure Code 1-T1015
  • Medical Transportation Program

Effective for Dates of Service on or After September 1, 2024

• Calendar fee review for:
  • Cardiovascular System Surgery
  • Digestive System Surgery
  • Eye and Ocular Adnexa Surgery
  • Physician Administered Drugs – Non-Oncology
  • Physician Administered Drugs – Oncology
  • Physician Administered Drugs – Vaccines & Toxoids
  • Proton Therapy
  • R Codes
  • Renal Dialysis Medication
  • T Codes
  • Urinary System Surgery
  • Respiratory System Surgery
  • Vision Device
• Medical policy review for:
  • Biomarkers (SB 989)
  • Home Telemonitoring (G0511)
  • Office Setting Skin Substitutes
  • Physician Administered Drugs – Non-Oncology (J0131)
  • Renal Dialysis Procedure Code J1756
• Healthcare Common Procedure Coding System (HCPCS) for:
  • Third Quarter HCPCS Drugs
  • Fourth Quarter HCPCS Drugs

Next step for providers: Providers should share this communication with their staff. 

References:

Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective January 1, 2024, and September 1, 2024

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/provideralerts.