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Reimbursement Rate Updates for COVID-19 Administration Procedure Codes 0164A and 0173A Effective December 8, 2022

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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.

Effective for dates of service on or after December 8, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the reimbursement rates for COVID-19 administration procedure codes 0164A and 0173A for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

TMHP will reprocess any affected claims that are identified. 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 Administration Procedure Codes 0164A and 0173A.

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