Provider Alert! COVID-19 Procedure Codes for the Introduction of Infusion of Therapeutics

Date: January 6, 2021
Attention: All Providers

Effective Date: For dates of service on or after August 1, 2020

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.

Call to action: Texas Children’s Health Plan (TCHP) aligns with the Centers for Medicare & Medicaid Services (CMS) in response to the COVID-19 pandemic, with the implementation of the following 12 new procedures codes. Effective for dates of service on or after August 1, 2020, the following procedure codes will become a benefit for Texas Medicaid:

These codes describe the introduction or infusion of therapeutics, including remdesivir and convalescent plasma, into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).

How this impacts providers: Information on claims:

• Denied claims with dates of service on or after August 1, 2020 must be automatically reprocessed for appropriate payment no later than December 15, 2020, and providers may receive an additional payment.
• The 95-day filing deadline will be waived for any claims that were not submitted prior to these codes being established.
• No interest is due to providers in either scenario.
• Providers are not required to appeal the claims unless they are denied for other reasons after the claims processing or reprocessing is complete.

Next steps for providers: Providers should share information on the new procedure codes 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.