On 08/10/2020 Texas Medicaid & Healthcare Partnership (TMHP) made an announcement that:
Effective for dates of service on or after April 1, 2020, procedure code S8301 for infection control supplies above and beyond normal protocol will become a benefit for Texas Medicaid.
Procedure code S8301 may be reported for any encounter 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.
Procedure code S8301 is reimbursed, in accordance with 1 TAC §355.8023.
Submitting claims- the providers may continue to bill as they normally do, but with these claims, they must submit copies of the appropriate receipts or invoices. Standard claims filing deadlines apply. Prior authorization is not required, but claims are subject to retrospective review.
When submitting the claims through Link, providers may submit receipts or invoices as attachments once the claim status says “Pending.” To learn more about checking claim status and adding attachments, go to UHCprovider.com/claims >Check Claim Status: Quick Reference, Tutorials and More > Self-Paced User Guide.
Previously submitted claims
If you’ve already submitted claims using procedure code S8301, with dates of service on or after April 1, 2020, your claims will be automatically reprocessed. Please don’t resubmit these claims.
Important: “above and beyond normal protocol?”
According to TMHP, commonly used supplies for a service or procedure are not considered “above and beyond normal protocol.” If gloves alone are enough under normal circumstances, that’s considered “normal protocol.” Any PPE used, in addition to the gloves in this example, would be considered “above and beyond normal protocol.”
Reimbursement: The reimbursement rate for this code is 35 percent of billed charges.
For more information, please visit the following links:
For the whole Texas COVID-19 Clarification Letter, please click here.
Procedure Code Addition and Update for Coronavirus (COVID-19) | TMHP info