Update to Texas Medicaid and CHIP Coverage for Monoclonal Antibody Therapy Code Q0222 

01/30/2023

What is new

Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid was notified, we have until March 11, 2023, to reprocess claims, if applicable, for procedure code Q0222 with dates of service from August 15, 2022, through November 29, 2022, for appropriate payment and claims processing.

Reimbursement

For procedure code Q0222, when it was supplied by the federal or state government, from dates of services August 15, 2022, through November 29, 2022, we must void and rebill for the administration only. Payment received for a government-provided product is considered an overpayment and is subject to recoupment.

Claims Reprocessing

Claims with procedure code Q0222 with dates of service from August 15, 20222 through November 29, 2022, BCBSTX will process claims for appropriate payment and does not require providers to submit an appeal unless they are denied for other reasons after the claims reprocessing is complete.

CMS Medicaid Toolkit  Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program.

Questions

Providers, for questions or additional information, please: