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Some COVID-19 Laboratory Procedure Codes Updated to Become Benefits for Pharmacists and Pharmacy Providers

Last updated on 4/26/2021

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 April 13, 2021, some COVID-19 laboratory procedure codes have been updated to become benefits for pharmacists and pharmacy providers when services are rendered to a Texas Medicaid client in an office setting.

Note: Pharmacies are considered office settings for pharmacists and pharmacy providers who provide these services.

The COVID-19 laboratory procedure codes listed in the following table are applicable for pharmacists and pharmacy providers when services are rendered in an office setting:

Procedure Codes

86318

86328

86408

86409

86413

86769

87426

87428

87635

87636

87637

87811

U0001

U0002

U0003

U0004

U0005

 

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