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Second Quarter 2025 HCPCS Updates for Texas Medicaid

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

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

Clinician-Administered Drug (CAD) Procedure Codes
C9174C9175J0165J0168J0616J0618J1163J1326J2312J2313
J3373J3374J3375J3391J7172J7356J9220J9276J9289J9342
J9382Q2058Q5099Q5100      

Reminder: The CAD procedure codes listed in the table above will be added as Medicaid benefits as of the Centers for Medicare & Medicaid Services (CMS) effective date, July 1, 2025. Claims will deny until a rate is implemented, but affected claims will be reprocessed back to the CMS effective date. The procedure codes will be payable at the July 1, 2025, published rate until the Texas Health and Human Services Commission (HHSC) rate hearing is held as required by the Texas Administrative Code §355.201.

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

The Healthy Texas Women (HTW) Program will add the following procedure codes as HTW Plus benefits:

CAD Procedure Codes
J2312J2313        

Effective July 1, 2025, the following procedure codes will be added as noncovered procedure codes for Texas Medicaid:

CAD Procedure Codes
J0166J0167J0169J9174J9275J9341Q5098Q5153  
Non-CAD Procedure Codes
9038290612906139063591323Q4368Q4369Q4370Q4371Q4372
Q4373Q4375Q4376Q4377Q4378Q4379Q4380Q4382  

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
C9174, J1326, J7356, J9276, J9289, J9382, Q205818 years of age or older
C91751 year of age or older
J3391Birth through 18 years of age
J717212 years of age or older
Q5099, Q51006 years of age or older

Procedure code J1326 will be restricted to the following diagnosis codes:

Diagnosis Codes
C155C158C159C160C161C162C163C164
C165C166C168C169    

Procedure code J9276 will be restricted to diagnosis codes C221, C23, C240, C248, and C249.

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

Diagnosis Codes
K5000K50011K50012K50013K50014K50018K50019K5010
K50111K50112K50113K50114K50118K50119K5080K50811
K50812K50813K50814K50818K50819K5090K50911K50912
K50913K50914K50918K50919K5100K51011K51012K51013
K51014K51018K51019K5120K51211K51212K51213K51214
K51218K51219K5130K51311K51312K51313K51314K51318
K51319K5180K51811K51812K51813K51814K51818K51819
K5190K51911K51912K51913K51914K51918K51919L400
L401L402L403L404L4050L4051L4052L4053
L4054L4059L408L409    

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)
  • Calcium chloride (procedure code J0618)
  • Vancomycin hydrochloride (procedure code J3373)

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
C9173C9303G9037G9038J0171J0173J2310J2311J3370J3371
J3372J9340        

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

CMS will discontinue procedure code M0248 effective December 12, 2024.

Second Quarter 2025 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
774359062099406C8005J1954J9292Q9998   

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
0552U0553U0554U0555U0556U0557U0558U0559U0560U0561U
0562U0563U0564U0565U0566U0567U0568U0569U0570U0571U
0572U0573U0574U0948T0949T0950T0951T0952T0953T0954T
0955T0956T0957T0958T0959T0960T0961T0962T0963T0964T
0965T0966T0967T0968T0969T0970T0971T0972T0973T0974T
0975T0976T0977T0978T0979T0980T0981T0982T0983T0984T
0985T0986T0987T       

CMS will revise the descriptions of the following informational procedure codes:

Procedure Codes
0285U0521U0522U0523U0524U0525U0526U0527U0528U0529U
0530U0531U0532U0533U0534U0535U0536U0537U0538U0539U
0540U0541U0542U0543U0544U0545U0546U0547U0548U0549U
0550U0551U        

For more information, call the TMHP Contact Center at 800-925-9126.