Note: A Texas Medicaid managed care organization (MCO) shall provide any medically necessary and Medicaid-covered services to the members who have enrolled in their MCO. Administrative procedures such as prior authorization, precertification, referrals, as well as claiming and filing of encounter data, may be very different not only from traditional Medicaid (fee-for-service) but from one MCO to another. Providers must, therefore, contact the particular MCO of the member for further details.

The Texas Medicaid & Healthcare Partnership (TMHP) discovered a problem with the static fee schedule update processed on April 15, 2025, where the Clinical Laboratory static fee schedule (PRCR494C) contained duplicate entries. TMHP has corrected the issue and will issue an off-cycle static fee schedule on June 16, 2025, including the revised Clinical Laboratory static fee schedule.

For additional details, contact the TMHP Contact Center at 800-925-9126.