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 October 11, 2022, for dates of service on or after August 15, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) will implement reimbursement rates for COVID-19 procedure code Q0222 (bebtelovimab COVID monoclonal antibody therapy) with a fee because the drug is no longer available free of charge for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.
Any affected claims that are identified will be reprocessed. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed.
To view the updates, click the following link: COVID-19 Procedure Code Q0222
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.