Skip to main content

Reimbursement Rate Updates for Procedure Codes 87636, 87637, and 87811 Effective October 6, 2020

Last updated on

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 October 6, 2020, the reimbursement rates for COVID-19 related procedure codes 87636, 87637 and 87811 will be updated.

The following link shows the updates: COVID -19 procedure codes 87636, 87637 and 87811

Affected claims with dates of service from October 6, 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.