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Reimbursement Rate Updates for Procedure Codes 86328, 86769, and 87426 Effective January 1, 2021

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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.

This is a correction to the article titled “Reimbursement Rate Updates for Procedure Codes 86328, 86769, and 87426 Effective January 1, 2020.”

The article incorrectly stated the effective date as December 29, 2020, for dates of service on or after January 1, 2020. Below is the revised information and correct date of service.

Effective for dates of service on or after January 1, 2021, the reimbursement rates for COVID-19 related clinical diagnostic laboratory services procedure codes 86328, 86769, and 87426 will be updated.

The following link shows the updates: COVID-19 Procedure Codes 86328, 86769, and 87426

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