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.