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 August 10, 2020, the reimbursement rates for COVID-19 related procedure codes 86408 and 86409 have been updated.
The following link shows the updates: COVID-19 procedure codes 86408 and 86409
Affected claims with dates of service from August 10, 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.