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First Quarter 2020 HCPCS Updates for Texas Medicaid

Last updated on 4/24/2020

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.

On March 31, 2020, TMHP will implement the first quarter 2020 Healthcare Common Procedure Coding System additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2020.

First Quarter 2020 HCPCS Added Procedure Codes

Clinician Administered Drug (CAD) Procedure Codes

C9053

C9056

C9058

Reminder: The clinician administered drug procedure codes listed in the table above will be added as Medicaid benefits as of the Centers for Medicare & Medicaid Services (CMS) effective date, April 1, 2020. Claims will deny until a rate is implemented, but affected claims will be reprocessed back to the CMS effective date. The procedure codes will be payable at the April 1, 2020, published rate until the HHSC rate hearing is held, as required by the Texas Administrative Code 355.201.

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

The following procedure codes will be added as non-covered procedure codes for Texas Medicaid:

Non-CAD Procedure Codes

G2168

G2169

 

CAD Procedure Codes

C9057

Limitations

Age limitations will apply for the following procedure codes:

Procedure Codes

Client age limitations

C9053

16 years of age and older

C9056

18 years of age and older

Procedure code C9056 will also be restricted to diagnosis codes E8020, E8021, and E8029.

Coronavirus Testing Procedure Codes

On March 12, 2020, TMHP implemented coronavirus testing procedure codes U0001 and U0002.

Effective April 1, 2020, coronavirus testing procedure codes U0001 and U0002 will be a benefit of Texas Medicaid for dates of service on or after February 4, 2020.

Note: Added procedure codes will not be reimbursed until the codes are reviewed and a rate hearing is held. Providers will be notified of any benefit changes in a future article.

Services provided before the rate hearing is completed and expenditures are approved will be denied with an explanation of benefits (EOB) 02008, “This procedure code has been approved as a benefit pending the approval of expenditures. Providers will be notified of the effective dates of service in a future notification if expenditures are approved.”

Once expenditures are approved, TMHP will automatically reprocess affected claims after April 1, 2020. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.

First Quarter 2020 HCPCS Discontinued Procedure Codes

Effective April 1, 2020, CMS will discontinue the following procedure codes:

Procedure Codes

0006U

G1000

First Quarter 2020 HCPCS Revised Procedure Codes

Procedure Codes

0154U

0155U

G2061

G2062

G2063

 

First Quarter 2020 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes

0163U

0164U

0165U

0166U

0167U

0168U

0169U

0170U

0171U

G1012

G1013

G1014

G1015

G1016

G1017

G1018

G1019

 

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