Medicaid Preferred Drug List and Formulary ChangesCambios en el formulario y la lista de medicamentos preferidos de Medicaid
The Vendor Drug Program (VDP) made changes to the Texas Medicaid drug formulary effective January 30, 2026. To learn more about formulary changes impacted, please click here for more information
El programa de medicamentos de proveedores de Texas (VDP) ha realizado cambios recientes en el formulario de medicamentos de Medicaid de Texas. Esto entrará en vigencia el 30 de enero de 2026
Para obtener más información sobre los cambios en el formulario afectados, visite el siguiente enlace para obtener más información
SNAP Update and ResourcesActualización y recursos de SNAP
On November 1, 2025, the requirements to receive and apply to the Supplemental Nutrition Assistance Program (SNAP) benefits have changed. To see the new policies to request SNAP benefits, click here and/or call 211 for SNAP assistance. Learn more
El 1 de noviembre de 2025, cambiaron los requisitos para recibir y aplicar para los beneficios del Programa de Asistencia Nutricional Suplementaria (SNAP, por sus siglas en inglés). Para consultar las nuevas políticas para aplicar para los beneficios de SNAP, haz clic aquí o llama al 211 para obtener ayuda de SNAP. Aprende Más
Transportation UpdateActualización de transporte
SafeRide Health (SRH) is the new provider for all NEMT rides to doctor appointments and pharmacy visits.
Depending on your needs, rides may include wheelchair-lift-equipped vehicles, stretcher vans, minivans, or ambulatory vans. Please let SRH know what type of ride you need when scheduling.
SafeRide Health (SRH) es el nuevo proveedor de todos los servicios de transporte médico que no son de emergencia (NEMT, por sus siglas en inglés) hacia consultas médicas y farmacias.
Según tus necesidades, los servicios de transporte pueden incluir vehículos con elevador para sillas de ruedas, camionetas con camilla, minivans o camionetas ambulatorias. Por favor, informa a SRH qué tipo de transporte necesitas al programar tu traslado.
Date: July 23, 2021
Attention: All Providers
Effective Dates: August 1, 2021 and November 1, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to 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: Services no longer requiring a prior authorization effective August 1, 2021 include the following:
Biofeedback Codes 90901, 90912, and 90913
Durable Medical Equipment (DME) repair over 35 units
Services requiring a prior authorization for dates of service on or after August 1, 2021 include the following:
Mobility Aides Code E1035 Transfer system
Breast reduction Code 19318
Vein procedure Code 36473
Services requiring a prior authorization for dates of service on or after November 1, 2021 include the following:
Durable Medical Equipment (DME) when billed amount exceeds $500- Miscellaneous Code T199
Prosthetics Code L8610 Ocular Implant
Cerebral Seizure Monitoring – Inpatient EEG for Codes:
o 95726
o 95700
o 95718
o 95720
o 95722
o 95724
• Clinician Administered Drug Code Q2026 Dermal filler
• Functional Endoscopic Sinus Surgery inpatient/outpatient for Codes:
o 31240
o 31253
o 31254
o 31255
o 31256
o 31257
o 31259
o 31267
o 31276
o 31287
o 31288
• Gait Trainer/Standers for Code E0641
• Joint Replacement inpatient/outpatient for Codes:
o 23470
o 23472
o 23473
o 23474
o 24360
o 24361
o 24362
o 24363
o 24370
o 24371
o 27120
o 27122
o 27125
o 27130
o 27132
o 27134
o 27137
o 27138
o 27412
o 27446
o 27447
o 27486
o 27487
o 29866
o 29867
o 29868
• Spinal Surgery for Members age 21 and older, STAR only for Codes:
o 22100
o 22101
o 22102
o 22110
o 22112
o 22114
o 22206
o 22207
o 22210
o 22212
o 22214
o 22220
o 22224
o 22532
o 22533
o 22548
o 22551
o 22554
o 22556
o 22558
o 22586
o 22590
o 22600
o 22610
o 22630
o 22633
o 22800
o 22802
o 22804
o 22808
o 22810
o 22812
o 22818
o 22819
o 22830
o 22849
o 22850
o 22852
o 22855
o 22865
o 22899
o 63001
o 63003
o 63005
o 63011
o 63012
o 63015
o 63016
o 63017
o 63020
o 63030
o 63040
o 63042
o 63045
o 63046
o 63047
o 63050
o 63055
o 63056
o 63064
o 63075
o 63077
o 63081
o 63085
o 63087
o 63090
o 63101
o 63102
o 63170
o 63172
o 63173
o 63185
o 63190
o 63191
o 63194
o 63195
o 63196
o 63198
o 63199
o 63200
o 63250
o 63251
o 63252
o 63265
o 63267
o 63268
o 63300
o 63301
o 63302
o 63303
o 63304
o 63305
o 63306
o 63307
o 63308
Next steps for providers: Providers should share these prior authorization requirements 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.
