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Second Quarter 2021 HCPCS Updates for Texas Medicaid

Last updated on 6/29/2021

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

On June 29, 2021, TMHP will implement the second quarter 2021 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2021.

Second Quarter 2021 HCPCS Added Procedure Codes

Clinician Administered Drug (CAD) Procedure Codes

C9075

C9077

C9078

C9079

J0224

J1951

J7168*

J9348

J9353

Q5123

   

Procedure codes noted with an asterisk in the table above will not require a rate hearing.

Reminder: The clinician administered drug procedure codes listed in the table above will be added as Medicaid benefits as of the Centers for Medicare & Medicaid Services (CMS) effective date, July 1, 2021. Claims will deny until a rate is implemented, but affected claims will be reprocessed back to the CMS effective date. The procedure codes will be payable at the July 1, 2021, published rate until the HHSC rate hearing is held, as required by the Texas Administrative Code 355.201.

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

Effective July 1, 2021, the following procedure codes will be added as non-covered procedure codes for Texas Medicaid:

CAD Procedure Codes

C9076

C9080

 

Non-CAD Procedure Codes

90626

90627

90671

90677

90758*

A9593

A9594

C1761

C9778*

G0327

   

Procedure codes noted with an asterisk in the table above will require a Texas Medicaid rate hearing.

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, 90758

18 years of age and older

Procedure code C9075 will be limited to diagnosis code G7101.

Procedure code C9079 will be limited to clients who are 12 years of age and older, and diagnosis code E7801.

Procedure code C9778 will be limited to female clients.

Procedure code J0224 will be limited to diagnosis code E7253.

Procedure code J9348 will be limited to clients who are 1 year of age and older, and the following diagnosis codes:

Diagnosis Codes

C7400

C7401

C7402

C7410

C7411

C7412

C7490

C7491

C7492

Coronavirus (COVID-19)-Related Procedure Codes

The following COVID-19-related procedure codes will be added as non-covered procedure codes for Texas Medicaid:

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.

Second 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 Contact Center at 800-925-9126.