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Heading: Providers Code Updates
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 2020 HCPCS Information

On January 1, 2020, the Texas Medicaid & Healthcare Partnership (TMHP) applied the 2020 annual Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that were effective for dates of service on or after January 1, 2020. Texas Medicaid is adopting a number of procedure codes during the 2020 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 2019 HCPCS web page.

 HCPCS 2020 News Articles

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