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COVID-19 Testing Procedure Codes 87636, 87637, and 87811 Are Now Benefits of the CSHCN Services Program

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Effective October 6, 2020, COVID-19 testing procedure codes 87636, 87637, and 87811 became benefits for the Children with Special Health Care Needs (CSHCN) Services Program.

Procedure codes 87636, 87637 and 87811 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 the rates are adopted by Texas Medicaid. 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-CSHCN Services Program Contact Center at 1-800-568-2413.