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First Quarter 2022 HCPCS Updates for Texas Medicaid

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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 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.

First Quarter 2022 HCPCS Added Procedure Codes

Clinician Administered Drug (CAD) Procedure Codes

C9093

J0219

J0491

J9071

J9273

J9359

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, April 1, 2022. Claims will be denied 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 April 1, 2022, published rate until the HHSC rate hearing is held, as required by Texas Administrative Code 355.201.

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

Effective April 1, 2022, the following procedure codes will be added as noncovered procedure codes for Texas Medicaid:

CAD Procedure Codes

C9090

C9091

C9092

J0879

Q5124

 

 

Non-CAD Procedure Codes

A2011

A2012

A2013

A4100

A4238

A9291

A9574

C9781

C9782

C9783

E2102

H2038

K1028

K1029

K1030*

K1031

K1032

K1033

Q4224

Q4225

Q4256

Q4257

Q4258

T2050

T2051

V2525

 

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 Limitation

J9273, J9359

18 years of age or older

Procedure code J0219 will be limited to clients who are 1 year of age or older and will require prior authorization.

Refer to: The current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 7.27.1, “Prior Authorization,” for enzyme replacement therapy prior authorization requirements.

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

Refer to: The current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 7.51, “Lupus Treatment Agents,” for prior authorization requirements for initial requests and recertifications or extensions.

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 descriptions 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 Contact Center at 800-925-9126.