The following information is effective April 1, 2008, unless otherwise indicated.
2008 HCPCS Procedure Code Additions
The following is a list of new procedure codes that do not replace existing procedure codes. All procedure codes that require a rate hearing are indicated in the Allowable column.
|
Procedure Code |
Allowable (Program) |
Limitations/Comments |
|
1-J1751 |
$11.69 |
Not covered by Medicare; Still covered by Medicaid |
|
1-J1752 |
$10.40 |
Not covered by Medicare; Still covered by Medicaid |
|
1-J7611 |
$0.10 |
Reinstated |
|
1-J7612 |
$0.99 |
Reinstated |
|
1-J7613 |
$0.07 |
Reinstated |
|
1-J7614 |
$1.39 |
Reinstated |
|
9-K0672 |
* |
New |
|
1-Q4096 |
NC |
New |
|
1-Q4097 |
NC |
New |
|
1-Q4098 |
NC |
New |
|
1-Q4099 |
NC |
New |
|
5-S3628 |
NC |
New |
|
(*) Allowable amount pending rate hearing. (NC) Not Covered. |
Description Changes
The descriptions for the following codes have changed. Providers must contact the appropriate copyright holder to obtain procedure code and modifier descriptions.
|
Code |
Effective Date(s) |
|
Procedure code 1-J0220 |
Effective January 1, 2008 |
|
Modifier KT |
Effective April 1, 2008 |
Discontinued Procedure Codes
Procedure codes 1-J7602 and 1-J7603 have been discontinued by the Centers for Medicare & Medicaid Services (CMS) and have no replacements. The discontinued procedure codes are no longer reimbursed after March 31, 2007.
Important Claims Filing Reminder
All of the new first quarter 2008 HCPCS codes are effective for dates of service on or after April 1, 2008, (unless otherwise indicated) for the Texas Medicaid Program, Medicaid Managed Care Program, and the CSHCN Services Program. Payable services provided before the rates are adopted through the rate hearing process will be denied as pending a rate hearing until the applicable reimbursement rate has been adopted. The client cannot be billed for these services. Providers are responsible for meeting the initial 95-day filing deadline. After the reimbursement rates have been implemented, the Texas Medicaid & Healthcare Partnership (TMHP) will automatically reprocess claims, and no further action on the part of the provider will be necessary.
Providers must submit the procedure codes that are most appropriate for the services provided, even if the procedure codes have not yet completed the rate hearing process and are denied as pending a rate hearing.
For procedure codes that require authorization or prior authorization but are awaiting a rate hearing, providers must follow the established authorization/prior authorization processes defined in the 2008 Texas Medicaid Provider Procedures Manual and the 2008 CSHCN Services Program Provider Manual as appropriate for the services provided in order to obtain a timely prior authorization. Retroactive prior authorization requests will not be granted; the requests will be denied as late submissions.
After the Texas Medicaid reimbursement rate has been determined through the rate hearing process, the CSHCN Services Program will evaluate the proposed rate to determine whether alignment with the Texas Medicaid rate is fiscally feasible. After the CSHCN Services Program reimbursement rate has been implemented, claims will be automatically reprocessed, and no further action on the part of the provider will be necessary. Providers will be notified of the implementation date and reprocessing efforts. The client cannot be billed for these services.
For more information, call the TMHP Contact Center at 1-800-925-9126, or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.