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Third Quarter 2022 HCPCS Updates for the CSHCN Services Program

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On September 29, 2022, TMHP implemented the third quarter 2022 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after October 1, 2022. The HCPCS updates are detailed in this article.

Third Quarter 2022 HCPCS Added Procedure Codes

Procedure Codes

87593*

A2014

A2015

A2016

A2017

A2018

A4596

A9602

A9607

A9800

C1834

C9101

C9142*

E0183*

G0310

G0311

G0312

G0313

G0314

G0315

J1302*

J1932*

J2777*

J9274

J9298*

Q2056

Q5125

T1032

T1033

Note: Procedure code 87593 will be effective for dates of service on or after July 26, 2022.

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 Centers for Medicare & Medicaid Services (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

C9142, J1302, J1932, J2777

18 years of age or older

J9298

12 years of age or older

Third Quarter 2022 HCPCS Discontinued Procedure Codes

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

Discontinued Procedure Codes

Direct Replacement Procedure Codes

C9094

J1302

C9095

J9274

C9097

J2777

Discontinued Procedure Codes with No Direct Replacement

0012U

0013U

0014U

0056U

C9096

C9098

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

Third Quarter 2022 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes

0094A

A9291

E0483

K1002

K1019

Q4128

Q9001

Q9002

Q9003

Third Quarter 2022 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes

0332U

0333U

0334U

0335U

0336U

0337U

0338U

0339U

0340U

0341U

0342U

0343U

0344U

0345U

0346U

0347U

0348U

0349U

0350U

0351U

0352U

0353U

0354U

90611

90622

Note: Procedure codes 90611 and 90622 will be effective for dates of service on or after July 26, 2022.

The description of procedure code 0276U will be revised.

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