March 01, 2023

Texas Medicaid: FMSA billing unit clarification

FMSA unit is now 1 per month per member

We want to clarify recent changes in the Financial Management Services Agencies (FMSA) billing unit. Please continue to bill FMSA units for STAR Kids and STAR+PLUS as 1 unit per month per member. Additionally, the FMSA code “T2040” should be paired with the appropriate modifier to avoid denied claims. By using the proper  STAR Kids, STAR+PLUS billing codes, claims will be paid at the appropriate rate of 1 unit per month per member.

Reminder: The claims’ filing deadline is 95 days from the date of service.

Disregard description information

Because the T2040 code is used nationally by the Centers for Medicare & Medicaid Services (CMS) and the UnitedHealthcare prior authorization and claims systems are shared by multiple states, the T2040 code description can’t be edited to indicate the HHSC update for Texas only.

Please disregard the information on your UnitedHealthcare authorization letters or on the UnitedHealthcare Provider Portal indicating 1 unit per 15 minutes. This information is not valid for Texas. You should continue to bill using the updated 1 unit per month per member rate.

Learn more

Go to our Long-Term Services and Supports (LTSS) STAR+PLUS and MMP and STAR Kids (including MDCP) Codes and Modifiers Guide for more information. You can also visit HHSC for the most recent Community First Choice payment rates.

Questions? We’re here to help.

For prior authorization questions, contact your service coordinator. For general questions, call Customer Service at 888-887-9003, 8 a.m.–6 p.m. CT, Monday–Friday.

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