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COVID-19 Testing Procedure Code 87428 Now a Benefit

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Effective November 10, 2020, COVID-19 testing procedure code 87428 became a benefit for Medicaid, Healthy Texas Women, and the Children with Special Health Care Needs Services Program.

Procedure code 87428 is a benefit for the following providers and places of service as listed in this table.

Note: The new procedure code 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 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 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.