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Second Quarter 2021 HCPCS Updates for the CSHCN Services Program

Last updated on 6/29/2021

On June 29, 2021, TMHP will implement the second quarter 2021 Healthcare Common Procedure Coding System additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2021. The HCPCS updates are detailed in this article.

Second Quarter 2021 HCPCS Added Procedure Codes

Effective July 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

90626

90627

90671

90677

90758

A9593

A9594

C1761

C9075

C9076

C9077*

C9078*

C9079

C9080

C9778*

G0327

J0224

J1951*

J7168*

J9348*

J9353*

Q5123*

 

 

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

Limitations

Age limitations will apply for the following procedure codes:

Procedure Codes

Client age limitations

J1951

2 years of age and older

C9077, C9078, J7168, J9353

18 years of age and older

Procedure code C9778 will be limited to female clients who are 18 years of age and older.

Procedure code J9348 will be limited to clients who are 1 year of age and older, and diagnosis codes C7490, C7491, and C7492.

Procedure code Q5123 will be limited to the following diagnosis codes:

Diagnosis Codes

C8300

C8301

C8302

C8303

C8304

C8305

C8306

C8307

C8308

C8309

C8330

C8331

C8332

C8333

C8334

C8335

C8336

C8337

C8338

C8339

C8510

C8511

C8512

C8513

C8514

C8515

C8516

C8517

C8518

C8519

C8520

C8521

C8522

C8523

C8524

C8525

C8526

C8527

C8528

C8529

C8580

C8581

C8582

C8583

C8584

C8585

C8586

C8587

C8588

C8589

C8590

C8591

C8592

C8593

C8594

C8595

C8596

C8597

C8598

C8599

C860

C861

C862

C863

C864

C865

C866

C9110

C9112

C9590

C9591

C9592

Coronavirus (COVID-19)-Related Procedure Codes

The following COVID-19-related procedure codes will be added as non-covered procedure codes for the CSHCN Services Program:

Procedure Codes

Effective Dates

M0201

June 8, 2021

M0244, M0246

May 6, 2021

M0248

May 26, 2021

Second Quarter 2021 HCPCS Discontinued Procedure Codes

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

Discontinued Procedure Codes

Direct Replacement Procedure Codes

C9074

J0224

C9132

J7168

Discontinued procedure codes will not be reimbursed after June 30, 2021.

First Quarter 2021 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes

0248U

0249U

0250U

0251U

0252U

0253U

0254U

0640T

0641T

0642T

0643T

0644T

0645T

0646T

0647T

0648T

0649T

0650T

0651T

0652T

0653T

0654T

0655T

0656T

0657T

0658T

0659T

0660T

0661T

0662T

0663T

0664T

0665T

0666T

0667T

0668T

0669T

0670T

 

The description of procedure code 0493T will be revised.

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