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COVID-19 Procedure Code Updates for Second Quarter 2022 HCPCS

Last updated on 8/17/2022

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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 June 23, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) implemented the second quarter 2022 Healthcare Common Procedure Coding System additions, which include new COVID-19 procedure codes.

Note: The new procedure codes will not be reimbursed until expenditures are approved and the rates are adopted by Texas Medicaid. Providers will be notified of any benefit changes in a future article.

Services provided before expenditures are approved will be denied with an explanation of benefits 02008: “This procedure code has been approved as a benefit pending the approval of expenditures. Providers will be notified of the effective dates of service in a future notification if expenditures are approved.”

Once expenditures are approved, TMHP will automatically reprocess the affected claims. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.

COVID-19 Vaccine Administration for Dental Providers

The following procedure codes will be benefits of Texas Medicaid when provided by a federally qualified health center (FQHC) and Texas Health Steps dental providers in the office setting:

Effective Dates of Service

Procedure Codes

Age Limitations

March 11, 2021

D1701, D1702

12 years of age or older

March 11, 2021

D1703, D1704, D1707

18 years of age or older

March 10, 2022

D1708, D1709

12 years of age or older

March 10, 2022

D1710, D1711, D1712

18 years of age or older

March 10, 2022

D1713, D1714

5 through 11 years of age

Note: Effective dates align with the date the procedure codes received approval by the American Dental Association.

The following procedure codes will be benefits of the Children with Special Health Care Needs (CSHCN) Services Program when provided by FQHC and dentist providers in the office and outpatient settings:

Effective Dates of Service

Procedure Codes

Age Limitations

March 11, 2021

D1701, D1702

12 years of age or older

March 11, 2021

D1703, D1704, D1707

18 years of age or older

March 10, 2022

D1708, D1709

12 years of age or older

March 10, 2022

D1710, D1711, D1712

18 years of age or older

March 10, 2022

D1713, D1714

5 through 11 years of age

Note: Effective dates align with the date the procedure codes received approval by the American Dental Association.

COVID-19 Testing Procedure Code 87913 Effective February 21, 2022

Procedure code 87913 will be a benefit of Texas Medicaid and the Healthy Texas Women (HTW) Program for the following providers and places of service:

Place of Service

Provider Type

Office

Physician assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS), physician, certified nurse midwife (CNM), registered nurse (RN), nephrology (hemodialysis, renal dialysis), and renal dialysis facility providers

Outpatient hospital

Hospital providers

Independent laboratory

Laboratory providers

Procedure code 87913 will be a benefit of the CSHCN Services Program for the following providers and places of service:

Place of Service

Provider Type

Office

Physician providers

Outpatient hospital

Hospital providers

Independent laboratory

Laboratory providers

Procedure code 87913 will also be a benefit of the Family Planning Program for FQHC and family planning clinic providers.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.