Provider Alert! COVID-19 Procedure Code S8301

Provider Alert! COVID-19 Procedure Code S8301

Date: November 19, 2021

Attention: All Providers

Effective date for new reimbursement information: November 1, 2021

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

The content in this message will remain in effect throughout the COVID-19 Disaster Declaration period as announced by the office of the Texas Governor, Greg Abbott. TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after April 1, 2020, procedure code S8301 may be reported for any encounter throughout the public health emergency in which personal protective equipment (PPE) above and beyond normal protocol is required to safely treat a patient with or without a diagnosis of COVID-19. For example, if under normal circumstances gloves alone are sufficient for the encounter, any additional PPE required is considered “above and beyond normal protocol”. Commonly used supplies for any given service/procedure is not considered “above and beyond normal protocol”. Procedure code S8301 does not require prior authorization.

Update effective for November 1, 2021: In order to streamline claims processing, TCHP has applied a set reimbursement rate of $7.50 for Code S8301. When billing for procedure code S8301, providers must attach the invoice with the MSRP as part of the regular claims process. Standard claims filing deadlines will apply. Procedure code S8301 may be reimbursed as follows:

If you have any questions, please email Health and Human Services Provider Enrollment at:

Place of Service Provider Type
Office County Indigent Health Care Program, Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife, Registered Nurse, Licensed Midwife, Dentistry Group
Home Home Health DME and Medical Supplier (DME) Providers, Home Health Agency
Outpatient Hospital Hospital Providers
Independent Laboratory Independent Laboratory/Privately Owned Laboratory Providers
Birthing Center Physician Providers, Certified Nurse Midwife, Registered Nurse, Licensed Midwife
Other Locations Physician Providers

How this impacts providers: Claims denied for Code S8301 where services were provided within the dates of service on or after April 1, 2020 will need to have the appropriate documentation attached to each denied claim and resubmitted as a corrected claim. Claims will be reimbursed according to accompanying receipts. For dates of service on or after November 1, 2021, providers will receive a set reimbursement rate of $7.50 when billing S8301. When billing for procedure code S8301, providers must attach the invoice with the MSRP as part of the regular claims process.

Next steps for providers: Providers should share this billing guidance with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers

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