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Reimbursement Rate Updates for Procedure Code 86413 Effective September 8, 2020

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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 December 29, 2020, for dates of service on or after September 8, 2020, the reimbursement rates for COVID-19 related procedure code 86413 will be updated.

The following link shows the updates: COVID -19 procedure code 86413

Affected claims with dates of service from September 8, 2020, through December 29, 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.

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