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First Quarter 2025 HCPCS Updates for the CSHCN Services Program

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On March 27, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) implemented the first quarter 2025 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2025. The HCPCS updates are detailed in this article.

First Quarter 2025 HCPCS Added Procedure Codes

Effective April 1, 2025, the following procedure codes will be added as noncovered procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program:

Procedure Codes
A2030A2031A2032
A2033A2034A2035
A6515*A6516*A6517*
A6518*A6519*A6611*
A9154A9611C8004
C8005C9300C9301
C9302C9303C9304
E0201E1022E1023
E1032*E1033*E1034*
E1832*G0183G0566
G0567J0281*J1072
J1271*J1299*J1308*
J1808*J1938*J2351*
J2428J2804*J2865*
J7521J9024*J9038
J9054J9161L0720*
L1933*L1952*L5827
L6028*L6029*L6030*
L6031*L6032*L6033*
L6037*L6700L7406
Q2057Q4354Q4355
Q4356Q4357Q4358
Q4359Q4360Q4361
Q4362Q4363Q4364
Q4365Q4366Q4367
Q5147Q5148Q5149
Q5150Q5151Q5152
Q9999S4024 

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 if a procedure code will not be reimbursed because the expenditures are not approved.

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
J2351, J902418 years of age or older

Procedure code E1032 will be limited to a maximum quantity of three per three years, and procedure code E1034 will be limited to a maximum quantity of one per three years. Procedure codes E1032, E1033, and E1034 will require prior authorization. Refer to the current CSHCN Services Program Provider Manual, “Durable Medical Equipment (DME),” subsection 17.3.19, “Wheelchairs,” for additional information.

Procedure code J1299 will be restricted to diagnosis codes D5932, D5939, D595, G360, G7000, and G7001.

Furosemide (procedure code J1938), when used for the treatment of end-stage renal disease or acute kidney injury, will be included in the composite rate payment and will not be paid separately.

The following procedure codes will require prior authorization:

Procedure Codes
E1832L0720L1933
L1952L6028L6029
L6030L6031L6032
L6033L6037 

Refer to the current CSHCN Services Program Provider Manual, “Orthotic and Prosthetic Devices,” subsections 28.3.1, “Prior Authorization and Documentation Requirements,” and 28.4.1, “Prior Authorization and Documentation Requirements,” for additional information.

First Quarter 2025 HCPCS Discontinued Procedure Codes

Effective April 1, 2025, CMS will discontinue the following procedure codes:

Procedure Codes
A9155G0564G0565
J1094J1300J1810
J1890J1940J9037
J9247L8010Q4231
Q5139S0017S0028
S0032S0039S4988

Discontinued procedure codes will not be reimbursed after March 31, 2025.

First Quarter 2025 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
99232A4453A4459
A6549A6583A6585
A6586A6587A6588
C1739C9793E1005
E1028E1801E1811
E1816E1818E1841
J9073L1932L1951
L1971L6692L6698
S4020S4021 

First Quarter 2025 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
0531U0532U0533U
0534U0535U0536U
0537U0538U0539U
0540U0541U0542U
0543U0544U0545U
0546U0547U0548U
0549U0550U0551U

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