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The $200,000 Inpatient Hospital Limitation Waived for COVID-19-Related Stays

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In response to the COVID-19 (coronavirus) health emergency, the Health and Human Services Commission has waived the $200,000 limitation for inpatient hospital stays related to COVID-19. The $200,000 waiver is for COVID-19-related hospitals stays that meet the criteria and are billed with the appropriate diagnosis codes detailed below.

Note: Clients hospitalized for reasons other than COVID-19 will be subject to the $200,000 limitation.

Details for Claims Submissions

Effective for admission dates on or after March 13, 2020, through March 31, 2020, for COVID-19 related hospital stays, the $200,000 hospital payment limitation has been waived when submitted with one of the following diagnosis codes listed in this table.

Affected claims with admission dates on or after March 13, 2020, through March 31, 2020, may be reprocessed, and providers may receive additional reimbursement, which will be reflected on future Remittance and Status (R&S) reports.

Effective for admission dates on or after April 1, 2020, for COVID-19 related hospital stays, the $200,000 hospital payment limitation has been waived when submitted with diagnosis code U071.

Affected claims with admission dates on or after April 1, 2020, may be reprocessed, and providers may receive additional reimbursement, which will be reflected on future Remittance and Status (R&S) reports.

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.