Provider Alert! COVID-19 Procedure Code S8301 Reimbursement Documentation Reminder

Date: April 25, 2022

Attention: All Providers

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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.

TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied for other reasons.

Providers should direct questions to their Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org.

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.

As a reminder, for manually priced DME/Supplies, providers must submit documentation of one of the following for consideration of purchase or rental with the appropriate procedure codes:

• The MSRP or average wholesale price (AWP), whichever is applicable
• The provider’s documented invoice cost. Handwritten alterations (crossing out of information or changing values) of the invoice render the invoice invalid.

Attachments submitted with claims and/or appeals should be reviewed to determine if manual pricing is required.

Guidance on product count missing from invoice:
If a provider receives invoices/receipts that show a box or carton was purchased, but the count and price per item was not on the receipt from the supplier, they need to follow these instructions.  TCHP is now accepting invoices with provider’s handwritten clarification noted as long as the original invoice data has not been changed. The actual count of supplies and price per item used to pay out the MSRP percentage is now required on the invoice.

Procedure code S8301 may be reimbursed as follows:

How this impacts providers: Claims denied for Code S8301 for dates of service between April 1, 2020 and October 31, 2021 will need to be resubmitted to include the required documentation as outlined above.

For dates of service on or after November 1, 2021, providers will receive a set reimbursement rate of $7.50 when billing S8301. Providers are still required to submit an invoice or MSRP for claim consideration.

Providers should follow the procedures as outlined above for manually priced DME supplies regarding the documentation.

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.