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Procedure Code Addition and Update for Coronavirus (COVID-19)

Last updated on 7/10/2020

This article has been updated, click here to see updates.

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.

Procedure Code S8301 Addition

Effective for dates of service on or after April 1, 2020, procedure code S8301 for infection control supplies above and beyond normal protocol will become a benefit for Texas Medicaid.

Procedure code S8301 may be reimbursed as follows:

Place of Service Provider Type
Office County Indigent Health Care Program, Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife, Registered Nurse, Licensed Midwife, Dentistry Group
Home Home Health DME and Medical Supplier (DME) Providers, Home Health Agency
Outpatient Hospital Hospital Providers
Independent Laboratory Independent Laboratory/Privately Owned Laboratory Providers
Birthing Center Physician Providers, Certified Nurse Midwife, Registered Nurse, Licensed Midwife
Other Locations Physician Providers

Once expenditures are approved, affected claims with dates of service on or after April 1, 2020 will automatically be reprocessed and providers may receive an additional payment. Additional payments will be reflected on Remittance and Status (R&S) Reports.

Note: Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.

Procedure Code 99001 Update

Effective for dates of service on or after April 1, 2020, the following place of service and provider types will be updated for procedure code 99001 for specimen collection services provided at drive-through testing sites during the Public Health Emergency. 

Place of Service Provider Type
Office County Indigent Health Care Program, Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife, Registered Nurse, Licensed Midwife Providers
Home Home Health DME and Medical Supplier (DME) Providers
Outpatient Hospital Radiation Therapy Center, Hospital, Family Planning Clinic, Nephrology (Hemodialysis, Renal Dialysis), and Renal Dialysis Facility Providers
Independent Laboratory Independent Laboratory/Privately Owned Laboratory and Radiation Therapy Center Providers

Note: Mobile units are considered “office.”

Affected claims with dates of service on or after April 1, 2020 will be reprocessed and providers may receive an additional payment. Additional payments will be reflected on Remittance and Status (R&S) Reports.

Note: 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.