Provider Alert! Update to “Correction to Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes”
Date: July 7, 2022
Attention: Behavioral Health Providers
Effective date: March 1, 2022
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Behavioral health providers should note an update in the reimbursement rates for substance abuse disorder codes H0050 and T1007, effective for dates of service on or after March 1, 2022. See table below:
| TOS* | Procedure Code | Age Range | Facility (F) | Current Medicaid Fee | Percent Reduction | Current Adjusted Medicaid Fee | Medicaid Fee Effective 3/1/2022 | Percent Reduction | Adjusted Medicaid Fee Effective 3/1/2022 |
| 9 | H0050 | 0-999 | F | $26.93 | 0.00% | $26.93 | $26.93 | 0.00% | $26.93 |
| 1 | T1007 | 0-999 | F | $40.44 | 0.00% | $40.44 | $40.44 | 0.00% | $40.44 |
| *Type of Service (TOS): 1 = Medical Services | |||||||||
Resources: Health and Human Services (HHS) Provider Finance webpage at https://pfd.hhs.texas.gov/
Rate Packets information is available at https://pfd.hhs.texas.gov/rate-packets
Related provider alert: http://www.thecheckup.org/2022/04/06/provider-alert-age-and-diagnosis-restriction-updates-for-drug-procedure-codes-effective-march-1/
How this impacts providers: Any affected claims that are identified will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.
Next steps for providers: Providers should share this communication with their staff.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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