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Additional Procedure Code for COVID-19 (Coronavirus) Testing for Texas Medicaid

Last updated on 7/3/2020

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.

An additional procedure code for COVID 19 (coronavirus) testing is a benefit for Texas Medicaid, effective on or after the following date of service:

Date of Service

Procedure Code

June 25, 2020

87426

Note:   The new procedure code will not be reimbursed until expenditures are approved and Texas Medicaid adopts the rate. Providers will be notified of any benefit changes in a future article.

 

Procedure code 87426 may be reimbursed as follows:

Place of Service

Provider Type

Office

County Indigent Health Care Program, Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife, Registered Nurse, Licensed Midwife

Outpatient Hospital

Hospital Providers

Independent Laboratory

Independent Laboratory/Privately Owned Laboratory Providers

Services provided before expenditures are approved will be denied with an explanation of benefits 02008, “This procedure code has been approved as a benefit pending the approval of expenditures. Providers will be notified of the effective dates of service in a future notification if expenditures are approved.”

Once expenditures are approved, TMHP will automatically reprocess the affected claims. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.

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