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Update to ‘First Quarter 2019 HCPCS Updates for Texas Medicaid’

Last updated on 4/16/2019

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

This is an update to the article titled, "First Quarter 2019 HCPCS Updates for Texas Medicaid," which was published on this website March 29, 2019.

The clinician administered drug procedure codes listed in the table below will be added as Medicaid benefits as of the Centers for Medicare & Medicaid Services (CMS) effective date, April 1, 2019. Claims will deny until a rate is implemented, however affected claims will be reprocessed back to the CMS effective date. The procedure codes will be payable at the April 1, 2019, published rate until the Texas Health and Human Services Commission rate hearing is held, as required by the Texas Administrative Code 355.201.

First Quarter 2019 HCPCS Added Procedure Codes

Clinician Administered Drug (CAD) Procedure Codes
C9043 C9044 C9045 C9141

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

Limitations for Procedure Code C9044

Procedure code C9044 will be a benefit for clients who are 18 years old and older and will be restricted to the following diagnosis codes:

Diagnosis Codes
C4402 C44121 C441221 C441222 C441291 C441292 C44221
C44222 C44229 C44320 C44321 C44329 C4442 C44520
C44521 C44529 C44621 C44622 C44629 C44721 C44722
C44729 C4482 C4492        

Limitations for Procedure Code C9045

Procedure code C9045 will be a benefit for clients who are 18 years old and older and will be restricted to diagnosis codes C9140 and C9142.

For more information, call the TMHP Contact Center at 800-925-9126.