The Texas Health and Human Services Commission has a mosquito repellent benefit for Zika virus prevention year-round in Medicaid and other state programs. Those covered include pregnant women of any age, women and girls ages 10-55, and men and boys 14 and older in the following programs:

  • Medicaid
  • Children’s Health Insurance Program (CHIP)
  • CHIP-Perinatal
  • Healthy Texas Women
  • Children with Special Health Care Needs (CSHCN) Services Program
  • Family Planning Program
  • Title V Prenatal Medical Fee for Service Program

To learn more, visit Texas Health and Human Services Zika Medicaid Benefit.

IMPORTANT INFORMATION FOR PROVIDERS REGARDING ZIKA VIRUS TESTING

Effective for dates of service on or after May 5, 2017, laboratory providers must include modifier U4 with procedure code 86790, 87798, or 87799 when submitting a claim for Zika virus testing.

The care provider must inform the lab when testing is ordered for Zika so the lab will know to use modifier U4 on their claim. While the direct care provider orders the test, it is the lab who will submit the claim.

Procedure Codes Modifier Special Instruction
 86790, 87798, 87799  U4  Use for Zika virus testing*

*Prior Authorization is not required for Zika testing.

If you have any questions regarding this information please contact Provider Relations at 1-877-532-3778 x1507 Monday – Friday from 8am-5pm.

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