Medicaid Provider Information on COVID-19 Coverage

Updated 09/01/2021

Get the latest BCBSTX Medicaid Provider COVID-19 updates here and on our COVID-19 Related News section.

Check Member Eligibility and Benefits

Use the Availity® Provider Portal or your preferred vendor for eligibility and benefit verifications.

Prior Authorizations

The Texas Health and Human Services Commission (HHSC) is extending existing prior authorizations request that are set to expire through December 31, 2020, after which time the 90-day prior authorization extensions will come to an end due to COVID-19 issues. For more details, refer to the Existing Prior Authorizations 90-day Extension for Texas Medicaid article.

Claims for COVID-19 Testing

If you test a member for COVID-19 antibodies when it's medically necessary, medically appropriate and in accordance with generally consistent medical standards, submit the claim to us using the appropriate code.

  • Healthcare Common Procedure Coding System (HCPCS) code U0001
  • Healthcare Common Procedure Coding System (HCPCS) code U0002

For more detail on COVID-19 coding and guidance, refer to the American Medical Association website .

Out-of-Network Providers
If you are not in our networks, our allowed amount for U0001 and U0002 is consistent with Medicaid pricing.

Testing Coverage

Medicaid members won't pay copays, deductibles or coinsurance for:

  • Medically necessary lab tests to diagnose COVID-19
  • Testing-related visits related to COVID-19 with in-network providers, whether at a provider's office, urgent care clinic, emergency room or by telehealth. (Testing must be medically necessary, consistent with CDC guidance and at the direction of a doctor.)

Treatment Coverage

No cost sharing will apply for Medicaid members diagnosed with COVID-19. This applies to costs associated with COVID-19 treatment at in-network facilities and treatment for out-of-network emergencies from April 1 to August 31, 2020.

Telemedicine/Virtual Visits

Types of Telemedicine
There are three types of Virtual Visits for Medicaid - Telehealth Visits, Virtual Check-Ins and E-visits. For more details and HCPCS and CPT codes, refer to the Types of Telemedicine/Virtual Visits article.

Cost-Sharing for Telemedicine/Telehealth
No member cost-sharing for covered, medically necessary medical and behavioral health services delivered via telemedicine or telehealth by a qualified in-network provider.

Physical, Occupational, Speech Therapy Groups
Beginning March 18, 2020 physical, occupational, and speech therapist can provide telehealth services. This applies to existing members who have accessed service with the practice/provider within the last 24 months. We will process services in accordance with the member's benefit plan. State laws and regulations apply. We will provide additional communication if there are changes. For more details, refer to the UPDATED  Physical, Occupational, Speech Therapy Groups Accessing Telehealth Services End Dates Extended in Response to COVID-19 article.

Pharmacy

With AllianceRx Walgreens+PRIME home delivery pharmacy service, Medicaid members can get up to a 90-day supply their regular or long-term medicine mailed at one time.

What is the risk of COVID-19?

According to recent reports from the CDC, the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC's Coronavirus Disease 2019 (COVID-19) website. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by COVID-19.
We've developed a member-facing flier about COVID-19 that you may share with your patients.

More Information

Because this is a rapidly evolving situation, you should continue to use CDC guidance on COVID-19.
If you have any questions or need additional information, please contact your BCBSTX Network Management Representative.