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Second Quarter 2022 HCPCS Updates for the CSHCN Services Program

Last updated on 6/22/2022

On June 23, 2022, TMHP will implement the second quarter 2022 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2022. The HCPCS updates are detailed in this article.

Second Quarter 2022 HCPCS Added Procedure Codes

Procedure Codes

90854

A9596

A9601

C9094*

C9095

C9096*

C9097*

C9098

D1705

D1706

G0308

G0309

J0739

J1306

J1551*

J2356*

J2779

J2998

J3299*

J9331*

J9332*

Q4259

Q4260

Q4261

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: https://pfd.hhs.texas.gov/rate-packets

Limitations

Age limitations will apply for the following procedure codes:

Procedure Codes

Client Age Limitation

C9094, C9097, J3299, J9331

18 years of age or older

J1551

2 years of age or older

Procedure code J2356 will be limited to clients who are 12 years of age or older and restricted to diagnosis codes J4550 and J4551.

Procedure code J9332 will be limited to clients who are 18 years of age or older and restricted to diagnosis codes G700 and G7001.

Second Quarter 2022 HCPCS Discontinued Procedure Codes

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

Discontinued Procedure Codes

C9090

C9091

C9092

C9093

G9678

 

Discontinued procedure codes will not be reimbursed after June 30, 2022.

Second Quarter 2022 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes

90739

A2004

 

Second Quarter 2022 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes

0323U

0324U

0325U

0326U

0327U

0328U

0329U

0330U

0331U

0714T

0715T

0716T

0717T

0718T

0719T

0720T

0721T

0722T

0723T

0724T

0725T

0726T

0727T

0728T

0729T

0730T

0731T

0732T

0733T

0734T

0735T

0736T

0737T

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