MedicaidPrior AuthHigh impact
Reimbursement Rate Update for CSHCN Procedure Code E1032 Effective April 1, 2025
Texas Medicaid·TX · Pediatrics·Fee Schedule
Effective date
Apr 1, 2025
We identified it
Aug 7, 2026
Summary
Effective April 1, 2025, TMHP is updating reimbursement rates for HCPCS code E1032 (durable medical equipment) under the Texas CSHCN Services Program. Prior authorization is now required for this code. TMHP will automatically reprocess affected claims, with adjustments appearing on future remittance reports.
Action Required
Before April 1, 2025: (1) Billing team must update billing system to require prior authorization for all E1032 claims submitted to TMHP-CSHCN. (2) Update encounter forms and templates to flag E1032 as prior-auth-required. (3) Providers must obtain prior authorization before submitting E1032 claims. (4) Access the DME Procedure Code E1032 spreadsheet on tmhp.com to obtain updated reimbursement rates and incorporate into fee schedules. Claims submitted without prior authorization will be denied. (5) Monitor future Remittance and Status (R&S) Reports for claim adjustments on reprocessed claims. Contact TMHP-CSHCN Services Program Contact Center at 800-568-2413 with questions.