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Second Quarter 2025 HCPCS Updates for the CSHCN Services Program

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

Second Quarter 2025 HCPCS Added Procedure Codes

Effective July 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
903829061290613
9063591323C9174*
C9175J0165*J0166
J0167J0168*J0169
J0616*J0618*J1163*
J1326J2312*J2313*
J3373*J3374*J3375*
J3391J7172J7356
J9174J9220*J9275
J9276J9289*J9341
J9342*J9382Q2058
Q4368Q4369Q4370
Q4371Q4372Q4373
Q4375Q4376Q4377
Q4378Q4379Q4380
Q4382Q5098Q5099*
Q5100*Q5153 

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 they are fiscally feasible for the program.

Note: Procedure codes may receive a temporary or interim rate before they are presented at a rate hearing. TMHP will deny claims 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
C9174, J928918 years of age or older
Q5099, Q51006 years of age or older

The following injections, 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:

  • Metoprolol tartrate (procedure code J0616)
  • Vancomycin hydrochloride (procedure code J3373)

Procedure codes Q5099 and Q5100 will be restricted to the following diagnosis codes:

Diagnosis Codes
K5000K50011K50012
K50013K50014K50018
K50019K5010K50111
K50112K50113K50114
K50118K50119K5080
K50811K50812K50813
K50814K50818K50819
K5090K50911K50912
K50913K50914K50918
K50919K5100K51011
K51012K51013K51014
K51018K51019K5120
K51211K51212K51213
K51214K51218K51219
K5130K51311K51312
K51313K51314K51318
K51319K5180K51811
K51812K51813K51814
K51818K51819K5190
K51911K51912K51913
K51914K51918K51919
L400L401L402
L403L404L4050
L4051L4052L4053
L4054L4059L408
L409  

Second Quarter 2025 HCPCS Discontinued Procedure Codes

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

Discontinued Procedure CodesDirect Replacement Procedure Codes
C9300J9220
C9301Q2058
C9302J9276
C9304J7172
Discontinued Procedure Codes With No Direct Replacement
C9173C9303G9037
G9038J0171J0173
J2310J2311J3370
J3371J3372J9340

Discontinued procedure codes will not be reimbursed after June 30, 2025.

Procedure code M0248 will be discontinued effective December 12, 2024.

Second Quarter 2025 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
774359062099406
C8005J1954J9292
Q9998  

Note: Procedure code C8005 will be effective for dates of service on or after April 1, 2025.

Second Quarter 2025 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
0552U0553U0554U
0555U0556U0557U
0558U0559U0560U
0561U0562U0563U
0564U0565U0566U
0567U0568U0569U
0570U0571U0572U
0573U0574U0948T
0949T0950T0951T
0952T0953T0954T
0955T0956T0957T
0958T0959T0960T
0961T0962T0963T
0964T0965T0966T
0967T0968T0969T
0970T0971T0972T
0973T0974T0975T
0976T0977T0978T
0979T0980T0981T
0982T0983T0984T
0985T0986T0987T

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

Procedure Codes
0285U0521U0522U
0523U0524U0525U
0526U0527U0528U
0529U0530U0531U
0532U0533U0534U
0535U0536U0537U
0538U0539U0540U
0541U0542U0543U
0544U0545U0546U
0547U0548U0549U
0550U0551U 

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