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Additional Information for Coronavirus Testing Procedure Codes

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Additional information is available for coronavirus testing procedure codes that became a benefit of Texas Medicaid effective for dates of services on or after February 4, 2020.

The following procedure codes may be submitted by laboratory providers as indicated by the type of test that is performed:

Effective Dates of Service Procedure Codes Type of Test
February 4, 2020 U0001 The Centers for Disease Control and Prevention (CDC)-developed test kit
February 4, 2020 U0002 A laboratory test that is not the CDC-developed test kit (any technique)
March 13, 2020 87635 A laboratory test that is not the CDC-developed test kit (amplified probe technique)
April 10, 2020 86328 COVID-19 antibody testing performed using a single-step method immunoassay
April 10, 2020 86769 COVID-19 antibody testing performed using a multiple-step method
April 14, 2020 U0003 A laboratory test performed using high-throughput technologies, that is not the CDC-developed test kit (amplified probe technique)
April 14, 2020 U0004 A laboratory test performed using high-throughput technologies, that is not the CDC-developed test kit (any technique)

For more information, call the TMHP Contact Center at 800-925-9126.