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Reimbursement Rate Updates for Texas Medicaid Effective April 1 through the Remainder of the COVID-19 Disaster Declaration

Last updated on 7/8/2020

Information posted Month July 8, 2020

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 13, 2020, President Donald Trump issued Proclamation 9994 declaring a national emergency concerning the Novel Coronavirus Disease (COVID-19) Outbreak and Governor Greg Abbott declared a state of disaster in all Texas counties due to COVID-19. Subsequently, on March 19, Dr. John Hellerstedt, Commissioner of the Texas Department of State Health Services (DSHS), issued a Public Health Disaster Declaration in Texas.

The Texas Health and Human Services Commission (HHSC) is implementing temporary emergency payment rate increases for certain Medicaid providers to support access and safety during the disaster declaration related to COVID-19.

Effective June 4, 2020, for dates of service on or after April 1, 2020, reimbursement rates for COVID-19 related procedure codes S8301, 71250, and 71260 procedure codes were updated.

The emergency payment rate add-ons will be effective retroactive to April 1, 2020, and are assumed to conclude when the disaster declaration ends.

Effective for dates of services on or after April 1, 2020 through the remainder of the disaster declaration related to COVID-19:

Affected claims with dates of service from April 1, 2020, through June 4, 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. The emergency payment rate increases will be effective retroactive to April 1, 2020 and are assumed to conclude on August 31, 2020 or the end of the disaster declaration.

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


Related Files
Procedure Codes S8301, 71250 and 71260.xls
Attachment Size
Procedure Codes S8301, 71250 and 71260.xls (38 KB) 38 KB