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.
On March 12, 2020, TMHP began implementing the first quarter 2020 Healthcare Common Procedure Coding System (HCPCS) additions, which includes coronavirus testing procedure codes U0001 and U0002.
Effective April 1, 2020, coronavirus testing procedure codes U0001 and U0002 will be a benefit of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for dates of service on or after February 4, 2020.
Note: Added procedure codes will not be reimbursed until the codes are reviewed and a rate hearing is held. Providers will be notified of any benefit changes in a future article.
Services provided before the rate hearing is completed and expenditures are approved will be denied with an explanation of benefits (EOB) 02008, “This procedure code has been approved as a benefit pending the approval of expenditures. Providers will be notified of the effective dates of service in a future notification if expenditures are approved.”
Once expenditures are approved, TMHP will automatically reprocess affected claims after April 1, 2020. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.