COVID-19 Procedure Code Additions and Updates

Date: 10/12/20

Due to COVID-19, Texas Health and Human Services (HHS) has added new procedure codes as Medicaid benefits, effective for dates of service on or after April 1, 2020. Procedure codes S8301 and 99001 became a benefit for Texas Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS) and Superior HealthPlan Medicare-Medicaid Plan (MMP). Superior will reprocess denied claims for dates of services on or after April 1, 2020, to reimburse the allowed amount for procedure codes S8301 and 99001. These payments will be reflected on the provider’s Explanation of Payment (EOP) and no provider action is required.

See below for place of service and provider types related to these procedure codes:

Procedure Code S8301

Procedure code S8301 for infection control supplies above and beyond normal protocol may be reimbursed, at invoice cost or 38% of billed if no invoice is submitted, for the following place of service and provider type:

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

Procedure Code 99001

Procedure code 99001 for specimen collection services provided at drive-through testing sites during the public health emergency may be reimbursed with the following place of service and provider type:

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 Providers
Home	Home Health DME and Medical Supplier (DME) Providers
Outpatient Hospital	Radiation Therapy Center, Hospital, Family Planning Clinic, Nephrology (Hemodialysis, Renal Dialysis), and Renal Dialysis Facility Providers
Independent Laboratory	Independent Laboratory/Privately Owned Laboratory and Radiation Therapy Center Providers

*Mobile units are considered office.

For questions, please contact your Superior Account Manager.