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Second Quarter 2020 HCPCS Updates for the CSHCN Services Program

Last updated on 7/2/2020

On June 25, 2020, TMHP implemented the second quarter 2020 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2020. The HCPCS updates are detailed in this article.

Second Quarter 2020 HCPCS Added Procedure Codes

Procedure code J0691 will be a benefit for clients who are 18 years of age and older and will not require a rate review.

Effective July 1, 2020, 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

C1748

C1849

C9059

C9061

C9063

C9122

C9759*

C9760

C9762*

C9763*

C9764*

C9765*

C9766*

C9767*

G2170*

G2171*

J0223

J0591

J0742*

J0791*

J0896

J1201*

J1429

J1558*

J3399

J7169*

J7204*

J7333

J9177

J9198

J9246*

J9358*

Q4227

Q4228

Q4229

Q4230

Q4231

Q4232

Q4233

Q4234

Q4235

Q4236

Q4237

Q4238

Q4239

Q4240

Q4241

Q4242

Q4244

Q4245

Q4246

Q4247

Q4248

Q5119*

Q5120*

Q5121

 

Procedure codes noted with an asterisk in the table above will require a Texas Medicaid rate hearing.

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: hhs.texas.gov/about-hhs/communications-events

Specimen Collection for Coronavirus Testing

Effective for dates of service on or after March 1, 2020, procedure code C9803 will be a benefit of the CSHCN Services Program.

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

Services provided before 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.”

Second Quarter 2020 HCPCS Discontinued Procedure Codes

Effective July 1, 2020, the Centers for Medicare & Medicaid Services will discontinue the following procedure codes:

Procedure Codes

C9041

C9053

C9054

C9056

C9057

C9058

C9754

C9755

J9199

Procedure code C9054 will be replaced by procedure code J0691.

Discontinued procedure codes will not be reimbursed after June 30, 2020.

Second Quarter 2020 HCPCS Revised Procedure Codes

Procedure Codes

C9758

J7321

J9245

Q4176

 

 

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