Radiology Benefit Updates for Texas Medicaid Effective September 1, 2023

Date: August 30, 2023

Attention: All Providers

Effective Date: September 1, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that certain radiology benefit updates will be effective for Texas Medicaid for dates of service on or after September 1, 2023.

Major changes include the following:

• The addition of benefit information for magnetic resonance elastography (MRE)
• New benefit for ultrasound transient elastography (TE)

MRE (procedure code 76391) may be reimbursed for the diagnosis or monitoring of liver fibrosis or cirrhosis in clients suspected of having, or who have been diagnosed with, chronic liver disease.

Performance of MRE may be reimbursed up to two times per rolling year, but may not be reimbursed within six months following a liver biopsy or TE, as it is not medically necessary.

TE (procedure code 91200) may be reimbursed for the diagnosis or monitoring of liver fibrosis or cirrhosis in clients suspected of having, or who have been diagnosed with, chronic liver disease.

Procedure code 91200 will be limited to the following diagnosis codes:

Performance of TE may be reimbursed up to two times per rolling year, but may not be reimbursed within six months following a liver biopsy or MRE, as it is not medically necessary.

TE may be inappropriate and ineffective in clients with obesity, ascites, or narrow intercostal spaces.

Next steps for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.