February 21, 2022
What is New?
On Jan. 1, 2022, the U.S. Food and Drug Administration (FDA) added Veklury (remdesivir lyophilized injection) as a Texas Medicaid benefit. The procedure code J0248 is for patients in an outpatient setting.
Requirements for Billing:
- Members 12 years of age and older
- Weight at least 40 kg
- Have mild to moderate COVID-19
- High-risk for progression to severe COVID-19, including hospitalization or death
Additional Requirements for billing authorized by the FDA for Emergency Use Authorization (EUA) for the following populations:
- Members weighing between 3.5 kg to less than 40 kg, or pediatric patients under 12 years and weigh at least 3.5 kg
- Have mild to moderate COVID-19
- High-risk for progression to severe COVID-19, including hospitalization or death
Reimbursement:
For reimbursement Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid must submit a financial arrangement code (FAC) of “20” on each encounter.
Additional Information:
For more information, call the TMHP Contact Center at 1-800-925-9126.
Questions
For questions or additional information please:
- Contact your BCBSTX Medicaid Network team at 1-855-212-1615 or
- Submit via email Texas Medicaid Network Department
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.