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COVID-19 Testing Procedure Codes 86408 and 86409 Are Now Benefits

Last updated on 10/13/2020

Effective August 10, 2020, COVID-19 testing procedure codes 86408 and 86409 became benefits in the following programs: Medicaid, the Children with Special Health Care Needs (CSHCN) Services Program, Healthy Texas Women (HTW), and Family Planning Program.

Procedure codes 86408 and 86409 are benefits for the following providers and places of service listed in this table.

Note: The new procedure codes will not be reimbursed until expenditures are approved and Texas Medicaid adopts the rates. Providers will be notified of any benefit changes in a future article.

Services provided before the expenditures are approved will receive the following explanation of benefits (EOB) 02008 notification, “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 the affected claims. 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 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.