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Addition of Procedure Code 87426 COVID-19 Testing For HTW

Last updated on 1/7/2021

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 mcay differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective October 1, 2020, for dates of service on or after June 25, 2020, COVID-19 testing procedure code 87426 became a benefit of the Healthy Texas Women (HTW) program.

Procedure code 87426 is a benefit for the following providers and places of service:

Place of Service

Provider Type

Office

County Indigent Health Care Program, Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife, Registered Nurse, Family Planning Clinic

Outpatient Hospital

Hospital Providers

Independent Laboratory

Independent Laboratory/Privately Owned Laboratory Providers

Affected claims with dates of service between June 25, 2020, and October 1, 2020, were reprocessed and providers may have received an additional payment that would have been reflected on Remittance and Status (R&S) Reports.

For more information, call the TMHP Contact Center at 1-800-925-9126.