Skip to main content

Reimbursement Rate Updates for Procedure Codes C9056 and J0223

Last updated on 9/14/2020

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.

Effective August 27, 2020, for dates of service from April 1, 2020, through July 1, 2020, the reimbursement rates for procedure codes C9056 and J0223 have been updated.

Effective for dates of services on or after April 1, 2020

The following link shows the updates: Procedure Code C9056 

Affected claims with dates of service from April 1, 2020, through June 30, 2020, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.

Effective for dates of services on or after July 1, 2020

Procedure code C9056 has been replaced by procedure code J0223.

The following link shows the updates: Procedure Code J0223 

Affected claims with dates of service from July 1, 2020, through August 27, 2020, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.

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