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2009 HCPCS
On January 1, 2009, the Texas Medicaid & Healthcare Partnership (TMHP) applied the annual 2009 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that were effective for dates of service on or after January 1, 2009. Texas Medicaid is adopting a number of procedure codes during the 2009 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 2008 HCPCS web page. |
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| 2010 Annual HCPCS Updates
Information posted November 6, 2009: On January 1, 2010, TMHP will implement the annual Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that will be effective for dates of service on or after January 1, 2010. 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, 2009. Details of the changes to procedure codes will be published in the January 2010 HCPCS Special Bulletin, No. 2, which will be available by December 31, 2009, on this website. Providers will be mailed a printed copy of the bulletin in February 2010.
| | Third Quarter 2009 HCPCS Updates Now Available
Information posted September 25, 2009: The third quarter 2009 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after October 1, 2009, 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.
| | Third Quarter 2009 HCPCS Updates Coming October 1, 2009
Information psoted August 7, 2009: The third quarter 2009 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that will be effective for dates of service on or after October 1, 2009, will be available by October 1, 2009. Deleted procedure codes will no longer be benefits of Texas Medicaid, Medicaid Managed Care, or the Children with Special Health Care Needs (CSHCN) Services Program. Details of these changes will be available on the TMHP Code Updates – HCPCS web page on this website, and will also be published in the January/February 2010 Texas Medicaid Bulletin, No. 227, and the February 2010 CSHCN Services Program Provider Bulletin, No. 73.
| | Correction to “Correction to the 2009 HCPCS Special Bulletin, No. 221”
Information posted July 17, 2009: This is a correction to an article published on this website on January 30, 2009, titled “Correction to the 2009 HCPCS Special Bulletin, No. 221.” The article incorrectly stated that procedure code 1-99466 replaced discontinued procedure code 1-99440. The replacement procedure code for 1-99440 is 1-99465. Click on the title to view the details.
| | Second Quarter 2009 HCPCS Updates Now Available
Information posted June 19, 2009: The second quarter 2009 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after July 1, 2009, are now available. Deleted procedure codes are no longer benefits of Texas Medicaid, Medicaid Managed Care, or the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
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| | First Quarter HCPCS Changes for Texas Medicaid: Non-Warranty DME Repairs
Information posted June 19, 2009: Effective for dates of service on or after July 1, 2009, procedure code 9-K0739 may be billed with prior authorization for non-warranty repairs of durable medical equipment (DME). Procedure code 9-K0739 may be reimbursed to home health DME suppliers and medical DME suppliers in the home setting. Procedure code 9-K0739 will be denied if it is billed with the same date of service as procedure code 9-E1340 by any provider.
| | First Quarter HCPCS Changes for the CSHCN Services Program: Non-Warranty DME Repairs
Information posted June 19, 2009: Effective for dates of service on or after July 1, 2009, procedure code 9-K0739 may be billed with prior authorization for non-warranty repairs of durable medical equipment (DME). Procedure code 9-K0739 may be reimbursed in the home setting to home health DME suppliers, medical DME suppliers, and custom DME providers. Procedure code 9-K0739 will be denied if it is billed with the same date of service as procedure code 9-E1340 by the same provider.
| | Reimbursement Rate to Change for Procedure Code 9-S8265
Information posted June 5, 2009: On June 26, 2009, the Texas Medicaid reimbursement rate for procedure code 9-S8265 will change. The new reimbursement rate of $28.54 was adopted following a public rate hearing that was held on May 12, 2009, and is effective for dates of services on or after January 1, 2009. Affected claims 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. | | Second Quarter HCPCS Updates to Be Available July 1, 2009
Information posted May 8, 2009: On July 1, 2009, TMHP will implement second-quarter 2009 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions effective for dates of service on or after July 1, 2009. Deleted procedure codes will no longer be benefits of Texas Medicaid fee-for-service, Medicaid Managed Care, and the Children with Special Health Care Needs (CSHCN) Services Program. Details of these changes will be posted on this web page on July 1, 2009, and will also be published in the September/October 2009 Texas Medicaid Bulletin, No. 225 and the November 2009 CSHCN Services Program Provider Bulletin, No. 72. 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.
| | Update to 2009 HCPCS Immunization Procedure Codes and Components
Information posted May 8, 2009: This is an update to an article that was published in the January 2009 HCPCS Special Bulletin, No. 221, titled “Immunizations (Vaccine/Toxoids)” for Texas Medicaid and “Vaccine/Toxoids” for Children with Special Health Care Needs (CSHCN). The articles list procedure codes 90681 and 90696 as new immunizations but do not indicate the components that are associated with each procedure code.
Procedure code 90681 has one state-defined component, and procedure code 90696 has two state-defined components. The immunization administration codes for vaccines with one state-defined component do not require a modifier and two state-defined components should be billed with a U2 modifier.
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.
| | First Quarter 2009 HCPCS Updates Now Available
Information posted March 27, 2009: The first quarter 2009 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after April 1, 2009, are now available. Deleted procedure codes are no longer benefits of Texas Medicaid, Medicaid Managed Care, or the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
| | Claims Reprocessing for Procedure Code 1-99464
Information posted March 27, 2009: TMHP has identified an issue that impacts claims submitted before March 5, 2009, with dates of service on or after January 1, 2009, and procedure code 1-99464. Claims may have been denied in error with an explanation of benefits message that indicated that the services are not in line with medical policy. Procedure code 1-99464 may be reimbursed in line with medical policy and does not require medical review. Affected claims will be reprocessed, and payments will be adjusted accordingly. No further action on the part of the provider is necessary. | | Correction to article "Correction to the 2009 HCPCS Special Bulletin, No. 221"
Information posted March 12, 2009: This is a correction to an article published on the TMHP website at www.tmhp.com on January 30, 2009, titled "Correction to the 2009 HCPCS Special Bulletin, No. 221." The article indicated the incorrect type of service for procedure codes 93279, 93282, and 93289. These procedure codes are laboratory services, and the correct type of service is as follows: 5-93279, 5-93282, and 5-93289.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Correction to the 2009 HCPCS Special Bulletin, No. 221
Information posted January 30, 2009: This is a correction to the 2009 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 221. The bulletin indicates incorrect benefit information for the following procedure codes: 1-93279, 1-93282, 1-93289, 1-99460, 1-99462, 1 99463, 1-99464, and 1-99466. Click on the title to view the details.
| | Update to “Correction to the 2009 HCPCS Special Bulletin, No. 221”
This is a correction to a message that first appeared on the February 6, 2009, Remittance and Status (R&S) Report and an article that was published on this website at on January 30, 2009, titled “Correction to the 2009 HCPCS Special Bulletin, No. 221.” The articles stated that incorrect benefit information was published in the 2009 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 221, for procedure codes 5-93279, 5-93282, and 5-93289, and that these procedure codes would not be reimbursed retroactively to January 1, 2009. Procedure codes 5-93279, 5-93282, and 5-93289 will be a benefit retroactive to January 1, 2009, for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Once the reimbursement rates are implemented, affected claims will be reprocessed and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the complete corrected article. | | First Quarter HCPCS Updates to Be Available April 1, 2009
Information posted February 6, 2009: On April 1, 2009, TMHP will implement first quarter 2009 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions effective for dates of service on or after April 1, 2009. Click on the title to view the details.
| | Correction to the 2009 HCPCS Special Bulletin, No. 221
Information posted January 30, 2009: This is a correction to the 2009 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 221. The bulletin indicates incorrect benefit information for the following procedure codes: 1-93279, 1-93282, 1-93289, 1-99460, 1-99462, 1 99463, 1-99464, and 1-99466. Click on the title to view the details. | | Correction to “Restriction Changes for 2008 HCPCS Procedure Codes”
Information posted January 16, 2009: This is a correction to an article published in the July/August 2008 Texas Medicaid Bulletin, No. 216, titled “Restriction Changes for 2008 HCPCS Procedure Codes.” The article did not include a place of service change for procedure code 1-90772. Click on the title to view the corrected information. | | HCPCS Special Bulletin Now Available
Information posted December 31, 2008: Click the title to view the HCPCS Special Bulletin. |
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