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|
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:
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.