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Clarification to “Updated Medicaid Managed Care Long-Term Services and Supports (LTSS) Billing Matrices Effective December 1, 2022”

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This article contains important billing information for providers participating in the STAR+PLUS, Medicare-Medicaid Dual Demonstration (Dual Demonstration), STAR Kids, and STAR Health programs. This is a clarification to an article titled “Updated Medicaid Managed Care Long-Term Services and Supports (LTSS) Billing Matrices Effective December 1, 2022,” which was published July 12, 2022. This article contains updated links to long-term services and supports (LTSS) billing matrices that apply to the STAR+PLUS, Dual Demonstration, STAR Kids, and STAR Health programs.

In 2019, the Centers for Medicare & Medicaid Services (CMS) directed the Texas Health and Human Services Commission (HHSC) to update Texas Medicaid LTSS billing codes to comply with the National Correct Coding Initiative (NCCI). NCCI edits were required for both the STAR+PLUS and STAR Kids LTSS billing matrices. Effective December 1, 2022, community-based LTSS billing in STAR+PLUS and STAR Kids will be changed from one hour to 15-minute billing units, and the LTSS billing matrices will be updated with new procedure codes and modifier combinations.

Note: The STAR+PLUS matrix contains billing information for the STAR+PLUS and the Dual Demonstration programs. The STAR Kids matrix contains billing for the STAR Kids and STAR Health programs.

Services Provided on or After December 1, 2022

For services provided on or after December 1, 2022, providers must use the procedure codes and modifiers with the NCCI-related edits found in the following appendices:

Services Provided on or Before November 30, 2022

For services provided on or before November 30, 2022, providers must use procedure codes and modifier combinations without the NCCI-related edits found in the following appendices:

Providers can find more information in the following handbook appendices:

For additional information, contact Managed_Care_Initiatives@hhs.texas.gov.