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Reimbursement Rate Updates for COVID-19 Related Procedure Codes for the CSHCN Services Program

Last updated on 9/30/2020

Effective October 1, 2020, for dates of service on or after March 1, 2020, March 13, 2020, April 10, 2020, April 14, 2020, June 1, 2020, and June 25, 2020, reimbursement rates for procedure codes related to Coronavirus Disease 2019 (COVID-19) for Children with Special Health Care Needs (CSHCN) Services Program will be updated.

Effective for dates of services on or after March 1, 2020

COVID-19 HCPCS procedure codes G2023 and G2024, related to specimen collection.

COVID-19 Special Review Telephonic procedure codes 99441, 99442, and 99443.

Affected claims with dates of service from March 1, 2020, through October 1, 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 dates of services on or after March 13, 2020

COVID-19 HCPCS procedure code 87635, related to viral testing.

Affected claims with dates of service from March 13, 2020, through October 1, 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 dates of services on or after April 10, 2020

COVID-19 HCPCS procedure codes 86318, 86328, 86769, related to antibody testing.

Affected claims with dates of service from April 10, 2020, through October 1, 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 dates of services on or after April 14, 2020

COVID-19 HCPCS procedure codes U0003 and U0004, related to testing using high throughput technologies.

Affected claims with dates of service from April 14, 2020, through October 1, 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 dates of services on or after June 1, 2020

Procedure Codes 71250 and 71260

Affected claims with dates of service from June 1, 2020, through October 1, 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 dates of services on or after June 25, 2020

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

Affected claims with dates of service from June 25, 2020, through October 1, 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.

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