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 January 28, 2021, for dates of service on or after November 21, 2020, the reimbursement rate for COVID-19 administration procedure code M0243 will be updated for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.
The following link shows the updates: COVID-19 Administration Code M0243
Affected claims with dates of service from November 21, 2020, through January 28, 2021, 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 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.