On June 29, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the second quarter 2023 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2023. The HCPCS updates are detailed in this article.
Second Quarter 2023 HCPCS Added Procedure Codes
Effective July 1, 2023, 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 |
||
C9150 |
C9151* |
C9784 |
C9785 |
C9786* |
C9787 |
J0137 |
J0206 |
J0216 |
J0457 |
J0665* |
J0736 |
J0737 |
J1440* |
J1576* |
J1805* |
J1806 |
J1811 |
J1812 |
J1813 |
J1814 |
J1836 |
J1920* |
J1921 |
J1941* |
J1961 |
J2249* |
J2305* |
J2329* |
J2371* |
J2372* |
J2427* |
J2561* |
J2598* |
J2599* |
J2806 |
J7213* |
J9029 |
J9056* |
J9058 |
J9059 |
J9063 |
J9259 |
J9321 |
J9322 |
J9323 |
J9347 |
J9350 |
J9380 |
J9381 |
Q4272 |
Q4273 |
Q4274 |
Q4275 |
Q4276 |
Q4277 |
Q4278 |
Q4280 |
Q4281 |
Q4282 |
Q4283 |
Q4284 |
Q5131 |
Procedure codes noted with an asterisk in the table 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 program.
Note: Procedure codes may receive a temporary or interim rate before they are presented at 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 Services (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 notification if a proposed reimbursement rate will change or 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://pfd.hhs.texas.gov/rate-packets
Limitations
Procedure code J1440 will be restricted to diagnosis codes A0471 and A0472 and limited to clients who are 18 years of age or older.
Age limitations will apply for the following procedure codes:
Procedure Codes |
Client Age Limitation |
J1920 |
1 year of age or older |
J1576 |
2 years of age or older |
J7213 |
12 years of age or older |
C9151, J0665, J1805, J1941, J2249, J2305, J2329, J2427, J2598, J2599 |
18 years of age or older |
Second Quarter 2023 HCPCS Discontinued Procedure Codes
Effective July 1, 2023, the Centers for Medicare & Medicaid Services (CMS) will discontinue the following procedure codes:
Procedure Codes |
||
0053U |
0143U |
0144U |
0145U |
0146U |
0147U |
0148U |
0149U |
0150U |
C9146 |
C9147 |
C9148 |
C9149 |
J2370 |
S0020 |
S0030 |
S0073 |
S0077 |
Discontinued procedure codes will not be reimbursed after June 30, 2023.
Second Quarter 2023 HCPCS Revised Procedure Codes
The description of the following procedure codes will be revised:
Procedure Codes |
||
0044A |
0124A |
0134A |
0144A |
0154A |
0164A |
0173A |
91312 |
91313 |
91314 |
91315 |
91316 |
91317 |
J2426 |
Second Quarter 2023 HCPCS Informational Procedure Codes
The following procedure codes will be added as informational only:
Procedure Codes |
||
0387U |
0388U |
0389U |
0390U |
0391U |
0392U |
0393U |
0394U |
0395U |
0396U |
0397U |
0398U |
0399U |
0400U |
0401U |
0791T |
0792T |
0793T |
0794T |
0795T |
0796T |
0797T |
0798T |
0799T |
0800T |
0801T |
0802T |
0803T |
0804T |
0805T |
0806T |
0807T |
0808T |
0809T |
0810T |
The description of the following informational procedure codes will be revised:
Procedure Codes |
||
0022U |
0308U |
0356U |
0357U |
0358U |
0359U |
0360U |
0361U |
0362U |
0363U |
0364U |
0365U |
0366U |
0367U |
0368U |
0369U |
0370U |
0371U |
0372U |
0373U |
0374U |
0375U |
0376U |
0377U |
0378U |
0379U |
0380U |
0381U |
0382U |
0383U |
0384U |
0385U |
0386U |
For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.