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First Quarter 2021 HCPCS Updates for the CSHCN Services Program

Last updated on 3/29/2021

On March 30, 2021, TMHP will implement the first quarter 2021 Healthcare Common Procedure Coding System additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2021. The HCPCS updates are detailed in this article.

First Quarter 2021 HCPCS Added Procedure Codes

Effective April 1, 2021, the following procedure codes will be added as non-covered procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program:

Procedure Codes

A9592

C9074

C9776*

C9777

G2020

G2172

J1427

J1554

J7402*

J9037

J9349

K1013*

K1014

K1015

K1016

K1017

K1018

K1019

K1020

Q2053

S1091*

The 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 CSHCN Services Program.

Note: Procedure codes may receive a temporary or interim rate prior to being taken to a rate hearing. Claims will be denied until a rate or interim rate is applied. Any affected claims may be reprocessed according to the 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 banner message or notification if a proposed reimbursement rate will change or if a procedure code will not be reimbursed because the expenditures are not approved.

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

Age Limitations

The following procedure codes will be a benefit for clients who are 18 years of age and older:

Procedure Codes

J9349

J7402

S1091

First Quarter 2021 HCPCS Discontinued Procedure Codes

Effective April 1, 2021, CMS will discontinue the following procedure codes:

Discontinued Procedure Codes

Direct Replacement Procedure Codes

C9068

A9592

C9069

J9037

C9070

J9349

C9071

J1427

C9072

J1554

C9073

Q2053

C9122

J7402

Discontinued Procedure Codes with No Direct Replacement

0098U

0099U

0100U

J7333

J7401

K1010

K1011

K1012

 

Discontinued procedure codes will not be reimbursed after April 1, 2021.

First Quarter 2021 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes

81529

C9761

D1110

D1120

G2140

G9868

G9869

G9870

J7321

First Quarter 2021 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes

0017M

0242U

0243U

0244U

0245U

0246U

0247U

   

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