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.