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Second Quarter 2022 HCPCS Updates for Texas Medicaid

Last updated on 6/22/2022

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 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.

Second Quarter 2022 HCPCS Added Procedure Codes

Clinician Administered Drug (CAD) Procedure Codes

C9094

C9095

C9096

C9097

J0739

J1306

J1551

J2356

J2779

J2998

J3299

J9331

J9332

   

Procedure code J2779 will not require a rate hearing.

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, July 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 July 1, 2022, published rate until the Texas Health and Human Services Commission (HHSC) rate hearing is held, as required by the 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

Limitations

Age limitations will apply for the following procedure codes:

Procedure Codes

Client Age Limitation

C9094, C9095, J1306, J9331

18 years of age or older

J0739

10 years of age or older

J1551

2 years of age or older

J2356

12 years of age or older

Procedure code C9096, which is a granulocyte colony stimulating factor, will be restricted by diagnosis.

Refer to subsection 6.23, “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim),” in the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook for a list of payable diagnosis codes for colony stimulating factors.

Procedure code J2356 will be restricted to diagnosis codes J4550 and J4551 for dates of service from July 1, 2022, through July 31, 2022.

Procedure code J2998 will be restricted to diagnosis code E8802.

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

Effective July 1, 2022, the following procedure codes will be added as non-covered procedure codes for Texas Medicaid:

CAD Procedure Codes

C9098

   

Non-CAD Procedure Codes

90584

A9596

A9601

D1705

D1706

G0308

G0309

Q4259

Q4260

Q4261

   

Second Quarter 2022 HCPCS Discontinued Procedure Codes

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

Discontinued Procedure Code

Direct Replacement Procedure Code

C9093

J2779

Discontinued Procedure Codes With No Direct Replacement

C9090

C9091

C9092

G9678

   

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

Second Quarter 2022 HCPCS Revised Procedure Codes

The descriptions 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 Contact Center at 800-925-9126.