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.
Additional information is available for coronavirus testing procedure codes that became a benefit of Texas Medicaid effective for dates of services on or after February 4, 2020.
The following procedure codes may be submitted by laboratory providers as indicated by the type of test that is performed:
|Effective Dates of Service||Procedure Codes||Type of Test|
|February 4, 2020||U0001||The Centers for Disease Control and Prevention (CDC)-developed test kit|
|February 4, 2020||U0002||A laboratory test that is not the CDC-developed test kit (any technique)|
|March 13, 2020||87635||A laboratory test that is not the CDC-developed test kit (amplified probe technique)|
|April 10, 2020||86328||COVID-19 antibody testing performed using a single-step method immunoassay|
|April 10, 2020||86769||COVID-19 antibody testing performed using a multiple-step method|
|April 14, 2020||U0003||A laboratory test performed using high-throughput technologies, that is not the CDC-developed test kit (amplified probe technique)|
|April 14, 2020||U0004||A laboratory test performed using high-throughput technologies, that is not the CDC-developed test kit (any technique)|
For more information, call the TMHP Contact Center at 800-925-9126.