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Third Quarter 2020 HCPCS Updates for the CSHCN Services Program

Last updated on 9/28/2020

On September 29, 2020, TMHP will implement the third quarter 2020 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after October 1, 2020. The HCPCS updates are detailed in this article.

Third Quarter 2020 HCPCS Added Procedure Codes

Effective October 1, 2020, the procedure codes listed in the Added Procedure Codes table will be added as non-covered procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program. The procedure codes noted with an asterisk in the table linked above will require a Texas Medicaid rate hearing.

New benefits that are 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.

Note: Procedure codes may receive a temporary or interim rate prior to being taken to a rate hearing. Claims will be denied until a rate or interim rate is applied. Any affected claims may be reprocessed according to the Centers for Medicare & Medicaid (CMS) effective date.

After the rate hearing, expenditures must be approved before the rates are adopted by the CSHCN Services Program. 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: https://rad.hhs.texas.gov/rate-packets

Age Limitations

Age limitations will apply for the procedure codes listed in the Age Limitations table.

Third Quarter 2020 HCPCS Discontinued Procedure Codes

Effective October 1, 2020, CMS will discontinue the procedure codes listed in the Discontinued Procedure Codes table.

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

Third Quarter 2020 HCPCS Revised Procedure Codes

The descriptions of the procedure codes listed in the Revised Procedure Codes table will be revised.

Third Quarter 2020 HCPCS Informational Procedure Codes

The procedure codes in the Informational Procedure Codes table will be added as informational only.

Third Quarter 2020 HCPCS Modifier Updates

Click to view the Third Quarter 2020 HCPCS Modifier Updates table.

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