New Prosthesis Benefits for Texas Medicaid

Date: July 17, 2025 

Attention: All Providers 

Effective date: July 1, 2025

Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after July 1, 2025, prosthesis procedure codes L5827 and L6700 will be benefits of Texas Medicaid.

Procedure codes L5827 and L6700 will require prior authorization and be limited to clients who are birth through 20 years of age. Refer to the current Texas Medicaid Provider Procedures Manual (TMPPM), Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.20.2, “Prior Authorization and Documentation Requirements,” for additional information about prior authorization criteria.

Next steps: 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.