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Third 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 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.

Third Quarter 2022 HCPCS Added Procedure Codes

Clinician Administered Drug (CAD) Procedure Codes

C9142

J1302

J1932

J2777

J9274

J9298

Q2056

Q5125

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, October 1, 2022. Claims will deny 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 October 1, 2022, published rate until the 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

Non-CAD Procedure Codes

87593

E0183

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

The non-CAD procedure codes noted 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.

After the rate hearing, expenditures must be approved before the rates are adopted by Texas Medicaid. 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.

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

CAD Procedure Code

C9101

Non-CAD Procedure Codes

A2014

A2015

A2016

A2017

A2018

A4596

A9602

A9607

A9800

C1834

G0310

G0311

G0312

G0313

G0314

G0315

T1032

T1033

Limitations

Age limitations will apply for the following procedure codes:

Procedure Codes

Client Age Limitation

J1302, J9274, Q2056

18 years of age or older

J9298

12 years of age or older

Procedure code E0183 will require prior authorization.

Procedure code Q5125, which is a granulocyte colony stimulating factor, will be restricted by diagnosis.

Refer to: The current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.24 “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim),” for a list of payable diagnosis codes for colony stimulating factors.

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 Contact Center at 800-925-9126.