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Reimbursement Rate Updates for COVID-19 Monoclonal Antibody Infusion Procedure Codes

Last updated on 9/28/2021

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.

On September 23, 2021, the reimbursement rates for monoclonal antibody infusion procedure codes for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program were implemented for dates of service on or after May 6, 2021, May 26, 2021, and July 30, 2021.

Effective for Dates of Service on or After May 6, 2021

Click the link below for the updated rates:

Effective for Dates of Service on or After May 26, 2021

Click the link below for the updated rates:

Effective for Dates of Service on or After July 30, 2021

Click the link below for the updated rates:

Affected claims, 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 800-568-2413.