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Reimbursement Rate Updates for Procedure Codes Related to COVID-19

Last updated on 6/26/2020

Information posted June 26, 2020

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.

Note: Rates as listed in these spreadsheets are to be effective for the duration of the federal emergency declaration. Following the conclusion of the emergency declaration, these rates will be reevaluated and potentially repriced according to Texas Health and Human Services (HHSC).

Effective June 4, 2020, for dates of service on or after March 1, 2020, March 13, 2020, April 10, 2020, and April 14, 2020, reimbursement rates for the following procedure codes related to COVID-19 will be updated.

Effective for dates of services on or after March 1, 2020

Effective for dates of services on or after March 13, 2020

  • COVID-19 HCPCS procedure code 87635, related to viral testing
    • Affected claims with dates of service from March 13, 2020, through June 4, 2020, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.

Effective for dates of services on or after April 10, 2020

Effective for dates of services on or after April 14, 2020

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

 

 

 

 

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