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Third Quarter 2023 HCPCS Updates for the CSHCN Services Program

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On September 28, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the third quarter 2023 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after October 1, 2023. The HCPCS updates are detailed in this article.

Third Quarter 2023 HCPCS Added Procedure Codes

Effective October 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
A2022A2023A2024
A2025A9156A9268
A9269A9292A9573
A9603A9697B4148
C9152*C9153*C9154*
C9155*C9156C9157*
C9158*C9788C9789
C9790C9791C9792
E0490E0491H2040
H2041J0349J0801*
J0802*J0874J0889
J2359*J2781*J7214*
J7353J7519*J9051*
J9064J9345*K1036
L1681L5991Q4285
Q4286V2526 

Procedure codes that are 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

The following procedure codes will be restricted to clients who are 18 years of age or older:

Procedure Codes
C9152C9153C9155
C9158J2781J9345

Procedure code C9157 will be restricted to diagnosis code G1221 and limited to clients who are 18 years of age or older.

Third Quarter 2023 HCPCS Discontinued Procedure Codes

Effective October 1, 2023, CMS will discontinue the following procedure codes:

Procedure Codes
0066U0357U0386U
0397UJ0800C9151

Discontinued procedure codes will not be reimbursed after September 30, 2023.

Third Quarter 2023 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
91304A4344J1921
K1004K1028 

Note: Procedure code 91304 will be effective for dates of service on or after August 14, 2023.

Third Quarter 2023 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
0019M0402U0403U
0404U0405U0406U
0407U0408U0409U
0410U0411U0412U
0413U0414U0415U
0416U0417U0418U
0419U  

The description of the following informational procedure codes will be revised:

Procedure Codes
0269U0271U0272U
0274U0277U0278U

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