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On January 1, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) applied the annual 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that were effective for dates of service on or after January 1, 2008. Texas Medicaid is adopting a number of procedure codes during the 2008 HCPCS implementation that must go through the rate hearing process, as required by Chapter 32 Human Resources Code, §32.0282, and Title 1 Texas Administrative Code (TAC) §355.201, which require public hearings to receive comments on Medicaid payment rates. This web page has been created to provide updates as reimbursement rates are established. Providers are encouraged to refer to the webpage regularly for these updates.
In addition to the rate hearings, House Bill 1, 80th Legislature, Regular Session, Article II, Department of State Health Services, Rider 79a mandates that the Children with Special Health Care Needs (CSHCN) Services Program notify the Legislative Budget Board (LBB) and the Governor 45 days before providing rate increases.
In compliance with these mandates, the CSHCN Services Program will evaluate the proposed rate after the rate hearing is complete and will then determine whether alignment with the Medicaid rate is fiscally feasible.
Once the reimbursement rate(s) have been implemented for individual procedure codes for the applicable program(s), claims will be automatically reprocessed, and no further action on the part of the provider will be necessary. Providers will be notified of the implementation date and reprocessing efforts. The client cannot be billed for these services.
Claims for procedure codes that require a rate hearing must be submitted within the initial 95-day filing deadline. The most appropriate procedure code for the service provided must be submitted. Services provided will be denied as pending a rate hearing until the applicable reimbursement rate is adopted.
Note: Click here to view the 2007 HCPCS web page. |
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Correction for Texas Medicaid Bulletin and HCPCS Special Bulletin Issue Numbering
Information posted November 28, 2008: The issue numbers for the March/April 2009 Texas Medicaid Bulletin and the 2009 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin have changed. Click on the title to view the details. | 2009 Annual HCPCS Updates
Information posted November 7, 2008: On January 1, 2009, TMHP will implement the annual Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after January 1, 2009. Deleted procedure codes will no longer be benefits of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program for dates of service after December 31, 2008. Details of the changes to procedure codes will be published in the January 2009 HCPCS Special Bulletin, No. 222, which will be available by December 31, 2008, on this website. Providers will be mailed a printed copy of the bulletin in February 2009. | Third Quarter 2008 HCPCS Updates Now Available
Information posted September 19, 2008: The third quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after October 1, 2008, are now available on the 2008 HCPCS/ICD-9-CM web page of the TMHP website at www.tmhp.com. Deleted procedure codes are no longer benefits of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program.
Details of these updates will also be published in the January/February 2009 Texas Medicaid Bulletin, No. 220, and the February 2009 CSHCN Services Program Provider Bulletin, No. 69. Click on the title to view the details. | Third Quarter 2008 HCPCS Updates Available October 1, 2008
Information posted August 8, 2008: On October 1, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) will implement third quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that will be effective for dates of service on or after October 1, 2008. Click on the title to view the details. | Second Quarter 2008 Healthcare Common Procedure Coding System (HCPCS) Updates
Information posted June 27, 2008: The second quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after July 1, 2008, are now available. Deleted procedure codes are no longer benefits of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. | New Rates for Drugs and DME
Information posted May 30, 2008: On May 19, 2008, the reimbursement rates for the following procedure codes were assigned at a public rate hearing: 1-90284, 9-A4252, 9-B4087, 9-B4088, 1-C9237, 1-C9238, 1-C9239, 1-C9240, 1-J0400, 1-J1571, 1-J1573, J/L-E2312, J/L-E2312-KC, J-E2313, 1-J2724, 1-J2778, 1-J7347, 1-J7349, 1-J9226, 1-J9303, and 9-K0672. Click on the title to view the details. | New Rates for Laboratory Procedures
Information posted May 30, 2008: On May 19, 2008, the reimbursement rates for eight laboratory procedure codes were adopted after a public rate hearing. Click on the title to view the details. | CSHCN Services Program Reimbursement Rates Assigned for Some 2008 HCPCS Procedure Codes
Information posted May 16, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has adopted the Texas Medicaid reimbursement rates for some 2008 annual Healthcare Common Procedure Coding System (HCPCS) procedure codes. The Texas Medicaid rates were adopted after a rate hearing held on March 18, 2008, and are effective June 1, 2008, for the CSHCN Services Program for dates of service on or after January 1, 2008. Claims submitted with any of the affected procedure codes will be reprocessed, and payments will be adjusted accordingly. No further action on the part of the provider is necessary. Click on the title to view the details. | Second Quarter 2008 HCPCS Updates Available July 1, 2008
Information posted May 9, 2008: On July 1, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) will implement second quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after July 1, 2008. Click on the title to view the details. | First Quarter 2008 Healthcare Common Procedure Coding System (HCPCS) Updates
Information posted March 31, 2008: The first quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after April 1, 2008, are now available. Deleted procedure codes are no longer benefits of the Texas Medicaid Program, Medicaid Managed Care Program, and Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. | Rates Assigned for Procedure Codes 1-C9236, 1-J1300, and 1-J9261
Information posted March 3, 2008: Rates for procedure codes 1-C9236, 1-J1300, and 1-J9261 were assigned after a public rate hearing on February 4, 2008. Click on the title to view the details. | Correction to the 2008 HCPCS Special Bulletin, No. 213: Procedure Code 1-S9152
Information posted February 25, 2008: This is a correction to the 2008 HCPCS Special Bulletin, No. 213. The bulletin incorrectly listed procedure code 1-S9152 as not covered by the Texas Medicaid Program or the CSHCN Services Program. Click on the title to view the complete, corrected information. | Benefit Update for Procedure Code W-D0145
Information posted February 18, 2008: This is an update to the 2007 HCPCS Special Bulletin, No. 200, and also to the 2008 Texas Medicaid Provider Procedures Manual, Section 19.15.2, “Diagnostic Services,” on page 19-10. The bulletin originally stated that effective for dates of service on or after January 1, 2007, procedure code D0145 is a benefit of the Texas Medicaid Program and the Children with Special Health Care Needs (CSHCN) Services Program for dental providers. Click on the title to view the details. | First Quarter HCPCS Updates To Be Available April 1, 2008
Information posted February 11, 2008: On April 1, 2008, TMHP will implement first quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions effective for dates of service on or after April 1, 2008. Deleted procedure codes will no longer be benefits of the Texas Medicaid Program, Medicaid Managed Care Program, and Children with Special Health Care Needs (CSHCN) Services Program. Details of these changes will be available on this website under the 2008 HCPCS webpage beginning April 1, 2008, and will also be included in the May/June 2008 Texas Medicaid Bulletin, No. 215 and the May 2008 CSHCN Provider Bulletin, No. 66. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413. | Update to the 2008 HCPCS Special Bulletin
Information posted February 4, 2008: This is an update to the 2008 HCPCS Special Bulletin, No. 213. The bulletin listed new procedure codes 7-01935 and 7-01936 as pending a rate hearing. Effective January 1, 2008, procedure codes 7-01935 and 7-01936 have been assigned a reimbursement rate of 5.00 relative value units (RVUs) multiplied by a conversion factor 19.83 (for clients 20 years of age or younger) or 16.72 (for clients 21 years of age or older). Claims submitted with dates of service on or after January 1, 2008, and procedure code 7-01935 or 7-01936 will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. | HCPCS Special Bulletin Number 213
Information posted January 21, 2008: The January 2008 HCPCS Bulletin No. 213 is now available. Click the title to view the bulletin. |
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