Date: May 21, 2025
Attention: Providers
Effective date: July 1, 2025
Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that on July 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will move the benefit information about joint injections and trigger point injections to the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook. It was previously in the in the Texas Medicaid Provider Procedures Manual (TMPPM) from the Outpatient Drug Services Handbook.
How this impacts providers: Enzyme injection procedure code 20527, which currently is a benefit of Texas Medicaid, will also be added to the procedure code table for trigger point injections.
Joint injections and trigger point injections are valid only in the treatment of acute conditions or the exacerbation of a chronic condition.
Texas Medicaid managed care organizations (MCOs) like TCHP must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in our MCO/TCHP. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should reference a member’s specific MCO/TCHP for information on these items. For TCHP, this information can be found on the provider page available here https://www.texaschildrenshealthplan.org/provider.
Next step 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: www.texaschildrenshealthplan.org/provideralerts.
