Skip to main content

First Quarter 2022 HCPCS Updates for the CSHCN Services Program

Last updated on

On March 24, 2022, TMHP implemented the first quarter 2022 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2022. The HCPCS updates are detailed in this article.

First Quarter 2022 HCPCS Added Procedure Codes

Procedure Codes

A2011

A2012

A2013

A4100

A4238

A9291

A9574

C9090

C9091

C9092

C9093*

C9781

C9782

C9783

E2102

H2038

J0219

J0491*

J0879

J9071*

J9273*

J9359*

K1028

K1029

K1030*

K1031

K1032

K1033

Q4224

Q4225

Q4256

Q4257

Q4258

Q5124

T2050

T2051

V2525

   

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 before a rate hearing is held. 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://pfd.hhs.texas.gov/rate-packets

Limitations

Procedure code J0491 will be limited to clients who are 18 years of age or older.

Procedure code J9273 will be limited to female clients who are 18 years of age or older.

Procedure code J9359 will be limited to clients who are 18 years of age or older and the following diagnosis codes:

Diagnosis Codes

C8330

C8331

C8332

C8333

C8334

C8335

C8336

C8337

C8338

C8339

   

First Quarter 2022 HCPCS Discontinued Procedure Codes

Effective April 1, 2022, CMS will discontinue the following procedure codes:

Discontinued Procedure Codes

0097U

0151U

C9084

C9085

C9086

C9087

G1009

M1145

 

Discontinued procedure codes will not be reimbursed after March 31, 2022.

First Quarter 2022 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes

0306U

0307U

0308U

0309U

0310U

0311U

0312U

0313U

0314U

0315U

0316U

0317U

0318U

0319U

0320U

0321U

0322U

 

The description of procedure codes 0022U and 3022F will be revised.

First Quarter 2022 HCPCS Modifier Updates

Modifier

Action

93

ADD

FT

REVISE DESCRIPTION

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