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 |
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90626 |
90627 |
90671 |
90677 |
90758 |
A9593 |
A9594 |
C1761 |
C9075 |
C9076 |
C9077* |
C9078* |
C9079 |
C9080 |
C9778* |
G0327 |
J0224 |
J1951* |
J7168* |
J9348* |
J9353* |
Q5123* |
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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 |
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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 |
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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 |
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The description of procedure code 0493T will be revised.
For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.