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Reimbursement Rate Updates for COVID-19 Related Procedure Code 87426 Effective June 25, 2020, for Medicaid

Last updated on 9/8/2020

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.

Effective September 3, 2020, for dates of service on or after June 25, 2020, reimbursement rates for COVID-19-related procedure code 87426 (Antigen Testing) will be updated for Texas Medicaid.

The following link shows the updates:

COVID-19-related procedure code 87426 (Antigen Testing)

Affected claims with dates of service from June 25, 2020, through September 3, 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 Duration of Emergency

The rates listed in the spreadsheet are effective for the duration of the federal emergency declaration. Following the conclusion of the emergency declaration, these rates will be re-evaluated and potentially repriced according to Texas Health and Human Services Commission methodology.

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