Medicaid Medical & Dental Policies

Texas HHSC ensures that policies are medically appropriate, patient-centered, transparent and based on the best available evidence. The agency’s medical and dental policies outline the types of procedures and treatments for which HHSC will pay for specific conditions.

Medical practitioners, program clients and the public can give HHSC feedback regarding new medical and dental policies or changes to existing policies.

Review the proposed policy or proposed changes to an existing policy, and then email your feedback to MCD Medical Benefits Policy.

The policies on this site are only drafts and are not considered final. While under review, the policies are open to comment. Please reference specific line numbers when providing feedback.

This website is not intended as a source of information concerning current medical policy or provider billing concerns. That information can be found at the Texas Medicaid and Healthcare Partnership website.

Current Texas Medicaid policies are available in the Texas Medicaid Provider Procedures Manual.

Draft Policies Available for Comment

House Bill (HB) 4 Telecommunications

In alignment with House Bill (HB) 4 (87th Legislative Session, 2021), HHSC has developed draft policy changes to allow covered services via telemedicine, telehealth, and audio-only delivery if clinically appropriate and cost effective. These policies are posted here for public comment. To learn more about implementation of HB 4 and the analysis framework, please go to the MCS Teleservices webpage.

  • The following document includes a list of telemedicine and telehealth definitions that will be forthcoming in an update to the Telecommunication Services Handbook policy: Telemedicine and Telehealth Definitions.

Case Management for Children and Pregnant Women (CPW)

  • Case Management for Children and Pregnant Women (CPW) policy

Medical and Nursing Specialist, Physicians and Physician Assistants Handbook

  • Physician Evaluation and Management (E/M) Services policy

School Health and Related Services (SHARS) Handbook

  • School Health and Related Services (SHARS) policy

Comments and Responses for Previously Posted Policies

  • There are currently no stakeholder comments and HHSC responses posted for previously posted comments.

How to Submit Proposals

If you would like to submit a proposal for a Medicaid medical or dental benefit, please complete the Topic Nomination Form and email it with supporting documentation to Medical Benefit Request.

Any interested member of the public is invited to submit a topic nomination form via the email address above. An email is sent back to the nominator acknowledging receipt of a topic nomination. Staff manage the mailbox and track progress of topic nominations under review.

Each topic nomination is reviewed and researched by a Medicaid medical or dental benefits policy analyst.

The review process includes conducting research on what other state Medicaid programs and other payers are covering, as well as analysis of the peer-reviewed literature and clinical guidelines for the nominated topic.

This information is then presented to an internal governance committee made up of Medicaid/CHIP services leadership for consideration. It can take HHSC up to 120 days after receipt to complete the review.

If a topic moves forward, the policy development process can take six to 18 months depending on the topic.

Each nominator will receive a response within one week after the governance committee meeting as to the outcome of the committee's decision.

Texas Medicaid will only consider coverage for services that have a permanent procedure code (CPT Level I or II) available for reimbursement. Emerging technologies, services and procedures assigned temporary procedure codes (CPT level III) cannot be considered.

Sign-up for Email Updates

If you wish to be informed of future opportunities to review medical and dental policy changes, please subscribe to GovDelivery for email announcements.