On January 1, 2017, the Texas Medicaid & Healthcare Partnership (TMHP)
applied the 2017 annual Healthcare Common Procedure Coding System (HCPCS)
additions, changes, and deletions that were effective for dates of service on or
after January 1, 2017. Texas Medicaid is adopting a number of procedure codes
during the 2017 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 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