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First Quarter 2024 HCPCS Updates for the CSHCN Services Program

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On March 28, 2024, Texas Medicaid & Healthcare Partnership (TMHP) will implement the first quarter 2024 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2024. The HCPCS updates are detailed in this article.

First Quarter 2024 HCPCS Added Procedure Codes

Effective April 1, 2024, the following procedure codes will be added as noncovered procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program:

Procedure Codes
A2026A4271A4438
A4564A4593A4594
A9293C9166C9167*
C9168C9796C9797
E0152E0468E0736*
E0738E0739E2104
G0138H0051J0177*
J0209J0577J0578
J0589J0650*J0651*
J0652*J1010*J1202
J1203J1323J1434
J2277J2782*J2801
J2919*J3055J3424
J7165J7354*J9073*
J9074J9075*J9248
J9249J9376K1037
L1320*L5783L5841*
Q4305Q4306Q4307
Q4308Q4309Q4310
Q5133Q5134S4988
S9002  

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.

Procedure code E2298 will be a benefit of the CSHCN Services Program and will not require a rate review.

Providers may also refer to the following website for details related to rate hearings: https://pfd.hhs.texas.gov/rate-packets

Additional Benefit Information

Procedure code E0736 will require prior authorization and be limited to clients who are 18 years of age or older. Additional criteria will be published in a future article.

Procedure code E2298 will require prior authorization and be limited to one purchase per five years. Refer to the current CSHCN Services Program Provider Manual, subsection 17.3.19.10, “Wheelchair Power Seat Elevation System,” for additional information about prior authorization criteria.

Procedure code J7354 will be restricted to diagnosis code B081 and limited to clients who are 2 years of age or older.

Procedure code L1320 will require prior authorization and be limited to clients who are birth through 20 years of age. Refer to the current CSHCN Services Program Provider Manual, subsection 28.3.1, “Prior Authorization and Documentation Requirements,” for additional information about prior authorization criteria.

Procedure code L5841 will require prior authorization and be limited to clients who are birth through 20 years of age. Refer to the current CSHCN Services Program Provider Manual, subsection 28.4.5, “Lower-Limb Prostheses,” for additional information about prior authorization criteria.

First Quarter 2024 HCPCS Discontinued Procedure Codes

Effective April 1, 2024, CMS will discontinue the following procedure codes:

Discontinued Procedure CodesDirect Replacement Procedure Codes
C9159J7165
C9160J0589
C9161J0177
C9162J2782
C9163J3055
C9164J7354
C9165J1323
E2300E2298
J0576J0577, J0578
J1020J1010
J2920J2919
J9070J9075
Discontinued Procedure Codes with No Direct Replacement
0354U0416UJ1030
J1040J1840J1850
J2930J9250Q4244

Discontinued procedure codes will not be reimbursed after March 31, 2024.

First Quarter 2024 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
1066F2060F3455F
A4561A4562E2001
J0208J0612J0613
J3380J3425J7516
J9029J9255J9260

Note: Procedure codes 1066F, 2060F, and 3455F will be effective for dates of service on or after January 1, 2024.

First Quarter 2024 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
0439U0440U0441U
0442U0443U0444U
0445U0446U0447U
0448U0449U 

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