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First Quarter 2018 HCPCS Updates for the CSHCN Services Program

Last updated on 3/30/2018

On March 15, 2018, TMHP implemented the first quarter 2018 Healthcare Common Procedure Coding System (HCPCS) additions, revisions and discontinuations, which will be effective for dates of service on or after April 1, 2018. The HCPCS updates are detailed in this article.

First Quarter 2018 HCPCS Added Procedure Codes

Effective April 1, 2018, the following procedure codes will be added as non-covered procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program:

Procedure Codes
C9462 C9463 C9464* C9465* C9466* C9467* C9468
C9469* C9749* K0903 Q2041 Q5103* Q5104*  
* = Texas Medicaid rate hearing required

New benefits adopted by Texas Medicaid must complete the rate hearing process to receive public comment on proposed Texas Medicaid reimbursement rates. The CSHCN Services Program reviews the adopted Texas Medicaid rates to determine whether the rates are fiscally feasible for the CSHCN Services Program.

After the rate hearing, expenditures must be approved before the rates are adopted by the CSHCN Services Program. Providers will be notified in a future banner message or notification if a proposed reimbursement rate will change or if a procedure code will not be reimbursed because the expenditures are not approved.

Providers may also refer to the following website for details related to rate hearings: hhs.texas.gov/about-hhs/communications-events/meetings-events

1st Quarter 2018 HCPCS Discontinued Procedure Codes

Effective April 1, 2018, the Centers for Medicare & Medicaid Services (CMS) will discontinue the following procedure codes:

Procedure Codes
Q5102

Discontinued procedure codes will not be reimbursed after March 31, 2018.

1st Quarter 2018 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
G0516 Q5101

1st Quarter 2018 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
G9873 G9874 G9875 G9876 G9877 G9878 G9879
G9880 G9881 G9882 G9883 G9884 G9885 G9890
G9891            

1st Quarter 2018 HCPCS Modifier Updates

Modifier

Action

QA

ADD

QB

ADD

QE

REVISE

QF

REVISE

QG

REVISE

QR

ADD

ZA

DISCONTINUE

ZB

DISCONTINUE

ZC

DISCONTINUE

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.