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Reimbursement Rate Updates for Procedure Code C9803 Effective March 1, 2020 for Medicaid, FPP, HTW, and the CSHCN Services Program

Last updated on 8/12/2020

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.

Effective August 13, 2020, for dates of service on or after March 1, 2020, reimbursement rates for COVID-19 related procedure code C9803 will be updated for Texas Medicaid, Healthy Texas Women (HTW), Family Planning Program (FPP), and the Children with Special Health Care Needs (CSHCN) Services Program.

The following link shows the updates:

COVID-19 Specimen Collection Procedure Code C9803

Affected claims with dates of service from March 1, 2020, through August 13, 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 Duration of Emergency

The rates listed in these spreadsheets are effective for the duration of the federal emergency declaration. Following the conclusion of the emergency declaration, these rates will be reevaluated and potentially repriced according to Texas Health and Human Services Commission methodology.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.