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.