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Third Quarter 2021 HCPCS Updates for the CSHCN Services Program

Last updated on 9/29/2021

On September 21, 2021, TMHP implemented the third quarter 2021 Healthcare Common Procedure Coding System additions, revisions, and discontinuations, which will be effective for dates of service on or after October 1, 2021. The HCPCS updates are detailed in this article.

Third Quarter 2021 HCPCS Added Procedure Codes

Effective October 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

A4453

C1831

C9081

C9082*

C9083*

C9084*

C9779

C9780

J0699*

J0741

J1305

J1426

J1445

J1448*

J2406

J7294

J7295

J9247*

J9318*

J9319*

K1021

K1022*

K1023

K1024

K1025

K1026

K1027

P9025*

P9026*

Q2054

Q4251

Q4252

Q4253

Q9004

S9432

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: rad.hhs.texas.gov/rate-packets

Limitations

Procedure codes J0699, J1448, J9247, J9318, and J9319 will be limited to clients who are 18 years of age and older.

Procedure code C9082 will be limited to clients who are 18 years of age and older, and diagnosis code C541.

Procedure code C9083 will be limited to clients who are 18 years of age and older, and the following diagnosis codes:

Diagnosis Codes

C3400

C3401

C3402

C3410

C3412

C342

C3430

C3431

C3432

C3480

C3481

C3482

C3490

C3491

C3492

Procedure code C9084 will be limited to clients who are 18 years of age and older, and the following diagnosis codes:

Diagnosis Codes

C8330

C8331

C8332

C8333

C8334

C8335

C8336

C8337

C8338

C8339

Procedure code K1022 will require prior authorization.

Coronavirus (COVID-19)-Related Procedure Codes

The following COVID-19-related procedure codes will be a benefit of the CSHCN Services Program for clients who are 12 years of age and older:

Procedure Codes

Effective Dates

M0244, M0246

May 6, 2021

M0240, M0241

July 30, 2021

M0248

May 26, 2021

Procedure codes M0240, M0241, and M0244 will be limited to diagnosis codes U071 and Z20822.

Procedure codes M0246 and M0248 will be limited to diagnosis code U071.

The following procedure codes will be added as informational only:

Procedure Codes

Effective Dates

M0249, M0250, Q0249

June 24, 2021

Q0240

July 30, 2021

The description of procedure codes 0003A and 0013A will be revised.

Third Quarter 2021 HCPCS Discontinued Procedure Codes

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

Discontinued Procedure Codes

Direct Replacement Procedure Codes

C9075

J1426

C9077

J0741

C9078

J1448

C9079

J1305

Discontinued Procedure Codes with No Direct Replacement

0139U

0168U

C9065

C9076

C9080

J0693

J7303

J9315

Q4228

Q4236

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

Third Quarter 2021 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes

J1443

J2407

K1013

Third Quarter 2021 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes

0018M

0255U

0256U

0257U

0258U

0259U

0260U

0261U

0262U

0263U

0264U

0265U

0266U

0267U

0268U

0269U

0270U

0271U

0272U

0273U

0274U

0275U

0276U

0277U

0278U

0279U

0280U

0281U

0282U

0283U

0284U

The description of procedure code 0051U will be revised.

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