Texas Medicaid: Payment platform adjustments coming soon

We’ll soon be implementing rate revisions across our payment platforms to align with updated guidelines from the Texas Health and Human Services Commission (HHSC). 

Once these rate revisions are implemented, you should no longer bill your claims with grouper and locality.

These rate revisions shift from the group rate and locality code method of payment for each procedure code and instead assigns fees by procedure code per the Ambulatory Surgical Center (ASC) / Hospital-based Ambulatory Surgical Center (HASC) Fee Schedule.

Background

HHSC adjusted schedules on the reimbursement method for ASCs and HASCs as of June 1, 2023, but waived implementation of this requirement for managed care organizations (MCOs) through Jan. 1, 2024. 

These updates were published in the Texas Medicaid Provider Procedures Manual on Oct. 1,2023.

For more information, please visit the Texas Medicaid and Healthcare Partnership at TMHP.com  > Providers > Fee Schedules

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