Updates to Prior Authorization for Services and Clinician-Administered Drug Benefits for HTW/HTW Plus
AI Summary
Effective July 1, 2026, Texas Medicaid will require prior authorization for MRI and other imaging services for HTW/HTW Plus programs, while adding new clinician-administered drug benefits. Several existing drug codes will no longer be covered HTW benefits.
Action Required
Before July 1, 2026: Billing team must update prior authorization requirements for HTW/HTW Plus MRI services (CPT 77046-77049, 70547-70548) and CT angiography services. Update billing system to allow new CAD codes J0281-S5550 for HTW and J0702-J7644 for HTW Plus. Remove discontinued HTW benefit codes J0695, J1551, J1611, J1729, J2402 from covered services list. Train staff on quantity limits for nutritional counseling and glucose testing supplies.
Affected Billing Codes
Plan Types
Medicaid
States
TX
Specialties
radiology, family-medicine, ob-gyn, endocrinology, diagnostic-imaging