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Third Quarter 2019 HCPCS Updates for the CSHCN Services Program

Last updated on 9/27/2019

On September 26, 2019, TMHP implemented the third quarter 2019 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after October 1, 2019. The HCPCS updates are detailed in this article.

Third Quarter 2019 HCPCS Added Procedure Codes

Procedure Code
J0291*
* = Rate review not required

Procedure code J0291 will be a benefit for clients who are 18 years old or older.

Effective October 1, 2019, 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
J0121  J0122  J0222  J0593  J1096  J1097  J1303
J1943  J1944  J2798  J3031  J3111  J7314  J7331
J7332  J7401  J9118  J9119  J9204  J9210  J9269
J9313  Q4205  Q4206  Q4208  Q4209  Q4210  Q4211
Q4212  Q4213  Q4214  Q4215  Q4216  Q4217   Q4218
Q4219  Q4220  Q4221  Q4222  Q4226  Q5116  Q5117
Q5118            

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 CSHCN Services Program adopts the rates. 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: www.hhs.texas.gov/about-hhs/communications-events/meetings-events.

Third Quarter 2019 HCPCS Discontinued Procedure Codes

Effective October 1, 2019, CMS will discontinue the following procedure codes:

Procedure Codes

C9035

C9036

C9037

C9038 C9039* C9040

C9043

C9044

C9045

C9048 C9049 C9050

C9051

C9052

C9447

J1942 S1090  

* = Replaced by procedure code J0291

Discontinued procedure codes will not be reimbursed after September 30, 2019.

Third Quarter 2019 HCPCS Revised Procedure Codes

The descriptions of the following procedure codes will be revised:

Procedure Codes

J0641

J2794

J7311

J7313 Q4122 Q4165 Q4184

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