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November 01, 2022

Texas Medicaid: STAR+PLUS billing unit change

FMSA unit now 1 per month

As a reminder, as of Sept. 1, 2022, you should bill Financial Management Services Agency (FMSA) units for STAR+PLUS as 1 unit per month. You can continue to bill using your normal billing process, however, update the unit from per 15 minutes to per month for the FMSA fee.

Consumer directed service Payment rate Unit
FMSA fee – New rate effective Sept. 1, 2022 $210.08 1 month

Background

Texas Health and Human Services Commission (HHSC) reviewed FMSA payment rates and methodology. As a part of the review, HHSC approved the billing unit change, effective Sept. 1, 2022.

You can find additional information about this change in HHSC’s Information Letter No. 2022-46 or view the most up-to-date payment rates for accurate billing.

What happens next

We are working to update our claims system to properly process these FMSA claims to reflect the unit and rate change. If your claims process prior to the system update, we will reprocess the claims automatically. Please do not re-submit incorrectly paid FMSA claims with dates of service after Sept. 1, 2022, as they will be denied as duplicate claims.

Questions?

For answers to specific questions, contact your provider advocate.

PCA-1-22-03375-C&S-News
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