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Certain COVID-19 Procedure Codes No Longer Benefits for Texas Medicaid

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective August 22, 2024, for dates of service on or after January 1, 2022, April 1, 2022, and November 30, 2022, certain COVID-19 procedure codes that were presented at a public rate hearing on August 2, 2024, will no longer be benefits for Texas Medicaid.

The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any affected claims that are identified. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed.

To view the updates, access the spreadsheets below:

COVID-19 End-Dated Procedure Codes Effective 1/24/2022.

COVID-19 End-Dated Procedure Codes Effective 4/5/2022.

COVID-19 End-Dated Procedure Codes Effective 11/30/2022.

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