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.

Note: Rates as listed in these spreadsheets are to be effective for the duration of the federal emergency declaration. Following the conclusion of the emergency declaration, these rates will be reevaluated and potentially repriced according to Texas Health and Human Services (HHSC).

Effective June 4, 2020, for dates of service on or after March 1, 2020, March 13, 2020, April 10, 2020, and April 14, 2020, reimbursement rates for the following procedure codes related to COVID-19 will be updated.

Effective for dates of services on or after March 1, 2020

• COVID-19 HCPCS procedure codes G2023 and G2024, related to specimen collection
• COVID-19 Special Review Telephonic procedure codes 99441, 99442 and 99443
• Affected claims with dates of service from March 1, 2020, through June 4, 2020, 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.

Effective for dates of services on or after March 13, 2020

• COVID-19 HCPCS procedure code 87635, related to viral testing
• Affected claims with dates of service from March 13, 2020, through June 4, 2020, 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.

Effective for dates of services on or after April 10, 2020

• COVID-19 HCPCS procedure code 87635, related to viral testing
• Affected claims with dates of service from March 13, 2020, through June 4, 2020, 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.

Effective for dates of services on or after April 14, 2020

• COVID-19 HCPCS procedure codes U0003 and U0004, related to testing using high throughput technologies
• Affected claims with dates of service from April 14, 2020, through June 4, 2020, 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.