HHSC Notices


Current 2023 Notices

New Texas Medicaid & Healthcare Partnership (TMHP) Contracts

Collaborative Care Model (CoCM) in Texas Medicaid Billing Case Study 


Hepatitis C Follow-up Information and Website Resources

Asthma Continuing Medical Education Webinar Notice

TAHP Availity Provider Letter for the Texas Facility Credentialing Application- Effective July 1, 2023


Providers Required to Update Their Practice Addresses in PEMS

Noninvasive Prenatal Screening Benefits to Change for Texas Medicaid July 1, 2023

HHSC Listening Session in Amarillo for LTSS Providers- No Wrong Door System- June 15, 2023

Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis CM

HHSC to Begin Collecting Financial Management Services Agency (FMSA) SFY 2022 Cost Survey - Due August 31, 2023

HHSC Listening Session in Pharr for LTSS Providers- No Wrong Door System- May 12, 2023

HHSC Listening Session in El Paso for LTSS Providers- No Wrong Door System- April 12, 2023

Provider Enrollment Revalidation Extensions to End on May 11, 2023

TMHP Provider Enrollment and Management System Video Resources

CLIA Certification Required for Laboratory Claims

HHSC Listening Session in San Antonio for LTSS Providers - No Wrong Door System - March 30 & 31, 2023

Diabetic Equipment and Supplies Benefits to Change for Texas Medicaid January 1, 2023

2022 Notices

Hepatitis C Treatment Coverage and PDL Update Scheduled for January 1

Clarification Regarding Outpatient Pharmacy CHIP Copayments for COVID-19 Vaccines Treatment and Testing

Texas Health Steps Informational Flyer - December 2022

 
Clinical Prior Authorization for Xenical No Longer Required After September 12
 
CHIP Vaccine Updates Effective September 1, 2022
 
Reimbursement Rate Updates for COVID-19 Vaccine Administration Procedure Code 0094A
 
COVID-19 Vaccine Administration Procedure Codes 0041A and 0042A Are Now Benefits
 
Woundex to Become a Payable Benefit Effective September 1, 2022
 
Brexanolone (Zulresso) Age Limitation Expanded Effective September 1, 2022
 
COVID-19 Vaccine Administration Procedure Codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A Are Now Benefits for Medicaid and CSHCN
 
COVID-19 Vaccine Administration Procedure Codes 0091A, 0092A, and 0093A Are Now Benefits
 
Novavax COVID-19 Vaccine Coverage Update


Benefit Criteria to Change for Vaccine Services Effective September 1, 2022

IHCPs using an IHCP-facility NPI Not Required to Submit Procedure Code Modifier(s) for General Medic
 

End-Stage Renal Disease Procedure Code E1629 to Become a Benefit

Prior Authorization Criteria Added for Tezepelumab-ekko (Tezspire) Procedure Code J2356 Effective August 1, 2022


Moderna COVID-19 Vaccine Administration Procedure Codes 0011A, 0012A, and 0013A Age Expansion

New Occurrence Span Code and Revenue Code for Acute Hospital Care at Home Program

Reimbursement Rates Implemented for Some Second Quarter HCPCS Drugs Procedure Codes for Medicaid Effective July 1, 2022
 
Telemedicine and Telehealth Services for the HTW and HTW Plus Programs
 
Telehealth Services for the Early Childhood Intervention Program
 
Texas Health Steps Preventive Care Medical Checkups Through Synchronous Audiovisual or Synchronous Telephone (Audio-only) to Be Allowed During a State of Disaster
 
Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective January 1, 2022, and September 1, 2022


Negative Pressure Wound Therapy to Become a Benefit Effective September 1, 2022

Telemedicine and Telehealth Benefit Information to Be Updated September 1, 2022

Reminder - Federal Entitlement to Medicaid and Early Childhood Intervention (ECI) Services
 
Clinical Prior Authorization Criteria Updates for Dupixent, Evrysdi, and Qelbree

Pediatric Updates for Moderna and Pfizer-BioNTech COVID-19 Vaccines

Tezspire (Tezepelumab-ekko) Update Effective July 1, 2022
 
Limitation Update for Diabetic Equipment and Supplies Procedure Code A4245
 
Injection Procedure Code J2020 – Zyvox (Linezolid) Now a Benefit for Texas Medicaid
 
COVID-19 Vaccine Administration Procedure Code 0074A Is Now a Benefit

Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective June 1, 2022


Updates to Age Restriction for Procedure Code 90619

COVID-19 Vaccine Administration Procedure Code 0094A Is Now a Benefit

Spikevax COVID-19 Vaccine Coverage Update

The Collaborative Care Model to Become a Benefit of Texas Medicaid June 1, 2022
 
Respiratory Syncytial Virus (RSV) Prophylaxis Season Reopening Across All Regions
 
Effective April 1, 2022, Reimbursement Rate Updates Implemented for Drug Procedure Code J7352

Pfizer-BioNTech COVID-19 Vaccine Booster Dose for Children Update

Moderna COVID-19 Vaccine Booster Dose Update

Changes for Client Access to Mosquito Repellent Benefit Effective June 1, 2022

Antivenin Procedure Code J0841 (ANAVIP®) to Become a Medicaid Benefit Effective June 1, 2022
 
Effective April 1, 2022, Reimbursement Rate Updates for Drugs with Procedure Codes C9093 and J9071
 
Some COVID-19 Procedure Codes Now Benefits for Pharmacists and Pharmacies Effective May 1, 2022
 
Push-Rim Activated Power Assist Wheelchair (PAPAW) System Procedure Code E0986 to Become a Benefit Effective June 1, 2022


Texas Health Steps Flexibilities for Telemedicine (Audio-visual) and Telephone (Audio-only) Delivery Training Ending at End of PHE

COVID-19 Convalescent Plasma Is a Benefit Effective December 28, 2021

COVID-19 Monoclonal Antibody Administration Procedure Codes M0222, M0223, and Q0222 for COVID-19 Now a Benefit

Monoclonal Antibody Procedure Code Q0221 for COVID-19 Now a Benefit

Effective April 1, 2022, Reimbursement Rate Updates for Drugs Procedure Codes

Update to Healthy Texas Women Claims for Telemedicine (Physician Delivered) and Telephone (Audio-only) Services

Reimbursement Rate Updates for Procedure Code J0248, Effective January 21, 2022
 
Age Range Updates for Procedure Codes Q0167, Q0169, and Q0175
 
Pegfilgrastim-cbqv (Udenyca) to be Diagnosis Restricted Effective May 1, 2022

Correction to “Effective October 1, 2021, Prostate Procedures for Benign Prostatic Hyperplasia Benefit Criteria to Change”

CHIP Co-Payments for MH/SUD Outpatient Office Visits & Residential Services Prohibited as of July 1 , 2022

Guidance for FMSAs on Consumer Directed Services (CDS) Employer Orientations

Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022

Correction to Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective March 1, 2022


Updates to Phosphate Binder Prior Authorization Criteria Scheduled for April 5, 2022

Cytokine and CAM Antagonists Criteria Updates Scheduled for April 5, 2022


Oxbryta Prior Authorization Criteria Updates Scheduled for April 5, 2022

Telemedicine and Telehealth Services Provided by Rural Health Clinics


Multiple Medicaid COVID-19 Flexibilities Extended Through April 30, 2022” to Permanently Implement Rural Health Clinic Flexibility

COVID-19 Vaccine Administration Procedure Codes 0051A, 0052A, 0053A, and 0054A Are Now a Benefit


Texas Medicaid Guidance in Response to Abbott’s Voluntary Recall of Certain Powdered Formulas

Updated Age Range for COVID-19 Vaccine Administration Procedure Code M0201

Texas Health Steps Quick Reference Guide Updated for March 2022

Rituximab Procedure Code J9312 to Be a Benefit of the CSHCN Services Program

Reimbursement Rate Changes for Some Procedure Codes for the CSHCN Services Program Effective April 1, 2022

Effective January 21, 2022, Procedure Code J0248 (Veklury) Is a Benefit

Gene Expression Profiling Procedure Code 81520 to Become a Benefit Effective April 1, 2022

Prior Authorization Criteria to Change for Omalizumab (Xolair) Effective March 1, 2022

QW Modifier Required for Procedure Code 87801

Reimbursement Rate Updates for COVID-19 Vaccine Administration Procedure Codes Effective January 3, 2022

COVID-19 At-home Test Kits Available as a Pharmacy Benefit

TMPPM Update for Enzyme Replacement Therapy Benefits


COVID-19 Vaccine Administration Procedure Code 0073A is Now a Benefit

Prior Authorization Criteria for Enzyme Replacement Therapy (ERT) Procedure Code C9085 Effective March 1, 2022
 
Prior Authorization Criteria for Anifrolumab-fnia (Saphnelo) and Belimumab (Benlysta) Effective March 1, 2022
 
QW Modifier Required for COVID-19 Testing Procedure Code 86328

Monoclonal Antibody Administration Procedure Codes M0220 and M0221 for COVID-19 Now a Benefit

COVID-19 Vaccine Administration Procedure Code 0004A Now a Benefit for Individuals 12 or Older

HHSC Interoperability and Health Information Exchange Survey for Behavioral Health Providers Available January 24, 2022 to February 18, 2022


Pneumococcal Vaccine Procedure Codes 90671 and 90677 to Become Benefits of Texas Medicaid March 1, 2022

Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes Effective March 1, 2022

Laser Interstitial Thermal Therapy to Require Prior Authorization Effective March 1, 2022

Prior Authorization Criteria for Surgical Implantation of HNS Effective March 1, 2022

Prior Authorization Criteria for Surgical Implantation of HNS Effective March 1, 2022 for the CSHCN Services Program

Benefit Criteria for Evoked Response Tests and Neuromuscular Procedures to be Added Effective March 1, 2022

Wound Care Procedure Code Benefits Changes Effective March 1, 2022

Renal Dialysis Benefits to Change Effective March 1, 2022

Benefit Criteria to Change for IV Therapy Equipment and Supplies Effective March 1, 2022

Maternal Opioid Misuse (MOM) Model

HHSC Release of Autism Services Benefits Effective February 1, 2022

HHSC Publishes Information on the Importance of Following EVV Rules and Policy Guidance for CDS Employers (IL 2021-49)

COVID-19 Vaccine Administration Procedure Code 0004A is Now a Benefit

Effective October 1, 2021, Prostate Procedures for Benign Prostatic Hyperplasia Benefit Criteria to Change

Reimbursement Rate Updates for Procedure Code Q5123 Effective July 1, 2021

Vision Services-Nonsurgical Benefits to Change Effective September 1, 2021

Lung Cancer Screening Benefits to Change for Texas Medicaid Effective September 1, 2021

Total Disc Arthroplasty Benefit Changes for CSHCN Effective September 1, 2021

Hepatitis B Vaccine Procedure Code 90739 to Become a Benefit Effective September 1, 2021

Diabetic Equipment and Supplies Benefits to Change for Texas Medicaid September 1, 2021

Subcutaneous Internal Cardiac Defibrillator (S-ICD) to Become a Benefit Effective September 1, 2021

Effective September 1, 2021, Chromosomal Microarray to Become A Benefit of Texas Medicaid

Procedure Code 90697 to Become Available for Texas Medicaid, Texas Health Steps, and the CSHCN Services Program Clients

Prior Authorization Criteria Added for Casimersen (Amondys 45) Effective September 1, 2021

Developmental Screening and Mental Health Screening Tools added for Texas Health Steps

New HTW Provider Certification Requirements - Effective June 1, 2021

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