Procedure and diagnosis codes change over time as new codes are added and existing codes are redefined or deleted. TMHP applies the International Classification of Diseases, Tenth Revision (ICD-10) additions, changes and deletions on October 1st of each year. TMHP makes most Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions on January 1st of each year and smaller updates throughout the year.
Some new or changed procedure codes must go through a Medicaid rate hearing process. After the rate hearing, the CSHCN Services Program evaluates the proposed rate and determines whether it is fiscally feasible to align with the Medicaid rate.
Providers must submit claims for procedure codes that require a rate hearing in accordance with the rules that are specified in the most current Texas Medicaid Provider Procedures Manual or CSHCN Services Program Provider Procedures Manual. After the rate hearing has established the reimbursement rates and they have been implemented, claims will automatically be reprocessed, and providers don’t need to take any further action. TMHP will notify providers of the implementation and reprocessing details through provider notifications, which are displayed in the Recent News sections of the relevant pages on this website. Providers are encouraged to check this site often for details.