10/22/2025

What’s new?

Texas Medicaid will update certain private duty nurses benefit information effective for dates of service on or after Nov. 1, 2025. Blue Cross and Blue Shield of Texas must follow all requirements for Medicaid private duty nursing services outlined in the Texas Medicaid Provider Procedures Manual. 

Texas Medicaid may also authorize a recertification for up to 180 calendar days if the member meets all the following criteria: 

• The member has received PDN services for at least 90 calendar days.
• The  member has experienced no significant changes in their condition for at least 90 calendar days.
• The provider does not expect any significant changes in the member’s condition.
• The member’s parent or guardian and provider all agree the recertification is appropriate. 

For additional information or plan of care requirements, refer to the Texas Medicaid Provider Procedures Manual.

For questions, contact our Medicaid Provider Network Team or call 855-212-1615.