First Quarter 2022 HCPCS Updates for the CSHCN Services Program
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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.
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.
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