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First Quarter 2023 HCPCS Updates for the CSHCN Services Program

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On March 30, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) implemented the first quarter 2023 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2023. The HCPCS updates are detailed in this article.

First Quarter 2023 HCPCS Added Procedure Codes

Procedure Codes

A2019

A2020

A2021

A4341

A4342

A4560

A6590

A6591

A7049

C9145

C9146*

C9147*

C9148

C9149

E0677

E0711

E1905

J0208*

J0218

J0612

J0613

J1411

J1449*

J1747

J2403

J9196*

J9294*

J9296*

J9297*

K1035

L8678

Q4265

Q4266

Q4267

Q4268

Q4269

Q4270

Q4271

Q5127

Q5128*

Q5129

Q5130

S9563

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 program.

Note: Procedure codes may receive a temporary or interim rate before they are presented at 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 notification if a proposed reimbursement rate will change or 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

Procedure codes C9146, C9147, J1449, and Q5128 will be limited to clients who are 18 years of age or older.

First Quarter 2023 HCPCS Discontinued Procedure Codes

Effective April 1, 2023, CMS will discontinue the following procedure codes:

Discontinued Procedure Codes

Direct Replacement Procedure Codes

J0610

J0612

J0611

J0613

Discontinued Procedure Codes with No Direct Replacement

0324U

0325U

C1834

Discontinued procedure codes will not be reimbursed after March 31, 2023.

First Quarter 2023 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes

A4628

J1954

K1019

M1209

Q5108

Q5111

Q5120

Q5122

S9562

First Quarter 2023 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes

0364U

0365U

0366U

0367U

0368U

0369U

0370U

0371U

0372U

0373U

0374U

0375U

0376U

0377U

0378U

0379U

0380U

0381U

0382U

0383U

0384U

0385U

0386U

M0010

The descriptions of procedure codes 0022U and 0095U will be revised.

First Quarter 2023 HCPCS Modifier Updates

Modifier

Action

JK

ADD

JL

ADD

LU

REVISE DESCRIPTION

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