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.
Beginning August 13, 2020, for dates of service on or after June 25, 2020, new procedure code 87426 will require modifier QW when billed.
Important: Providers must refer to the CMS CLIA website for a complete list of CLIA-waived tests, provider certifications, and billing requirements.
For more information about procedure code 87426, providers can refer to the article titled “Additional Procedure Code for COVID-19 (Coronavirus) Testing for Texas Medicaid,” which was published on this website on July 3, 2020.
For more information, call the TMHP Contact Center at 800-925-9126.