TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Coding > Procedure Coding


6.3.3 Procedure Coding

The procedure coding system used by Texas Medicaid is called the Healthcare Common Procedure Coding System (HCPCS). HCPCS provides health-care providers and third party payers a common coding structure that is designed around a five-character numeric or alphanumeric base for all codes.

HCPCS consists of two levels of codes including the Current Procedural Terminology (CPT®) Professional Edition (Level I) and the HCPCS codes approved and released by CMS (Level II).

At the beginning of each year, TMHP applies the annual HCPCS additions, changes, and deletions that include the program and coding changes related to the annual HCPCS, Current Dental Terminology (CDT), and CPT updates. These updates ensure an up-to-date coding structure by using the latest edition of the CPT and nationally established HCPCS codes released by CMS. Scheduled updates are announced in Medicaid bi-monthly bulletins.

Most added procedure codes that are not directly replacing a discontinued procedure code must go through the rate hearing process, as required by Chapter 32 of the Human Resources Code, §32.0282, and Title 1 of the Texas Administrative Code, §355.201, which require public hearings to receive comments on Texas Medicaid payment rates. The two levels of codes are as follows:

Texas Medicaid & Healthcare Partnership
CPT only copyright 2009 American Medical Association. All rights reserved.