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Reimbursement Rate Updates for COVID-19 Procedure Code 87428 Effective November 10, 2020

Last updated on 2/1/2021

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 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 10, 2020, the reimbursement rate for COVID-19 procedure code 87428 will be updated for Medicaid, the Children with Special Health Care Needs (CSHCN) Services Program, Healthy Texas Women (HTW), and the Family Planning Program.

The following link shows the updates: COVID-19 Code 87428

Affected claims with dates of service from November 10, 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 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.