Zika Virus Testing Requires Modifier U4 on Claims

Zika Virus Testing Requires Modifier U4 on Claims

Information posted May 5, 2017

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.

Effective for dates of service on or after May 5, 2017, laboratory providers must include modifier U4 with procedure code 86790, 87798, or 87799 when submitting a claim for Zika virus testing.

Procedure Codes Modifier Special Instruction
86790, 87798, 87799 U4 Use for Zika virus testing*

*Prior authorization is not required for Zika virus testing.

Important: To ensure laboratories are able to submit Zika virus testing claims correctly, the ordering provider must clearly indicate when a test is for Zika virus screening.

For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.

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