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Second Quarter 2023 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 Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

On June 29, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the second quarter 2023 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2023. The HCPCS updates are detailed in this article.

Second Quarter 2023 HCPCS Added Procedure Codes

Clinician-Administered Drug (CAD) Procedure Codes

C9151

J0137

J0206

J0457

J0665

J0736

J0737

J1440

J1576

J1805

J1806

J1812

J1814

J1836

J1920

J1921

J1941

J1961

J2249

J2305

J2329

J2371

J2372

J2427

J2561

J2598

J2599

J7213

J9056

J9059

J9063

J9323

J9347

J9350

J9380

J9381

Reminder: The CAD procedure codes listed in the table above will be added as Medicaid benefits as of the Centers for Medicare & Medicaid Services (CMS) effective date, July 1, 2023. 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 July 1, 2023, published rate until the Texas Health and Human Services (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

The following procedure codes will be added as Healthy Texas Women (HTW) and HTW Plus benefits:

CAD Procedure Codes

J0137

J0665

J0736

J0737

J1812

J1814

J1836

J1920

J1921

J2249

J2305

J2371

J2372

J2598

J2599

Effective July 1, 2023, the following procedure codes will be added as non-covered procedure codes for Texas Medicaid:

CAD Procedure Codes

J0216

J1811

J1813

J2806

J9029

J9058

J9259

J9321

J9322

Q5131

Non-CAD Procedure Codes

C9150

C9784

C9785

C9786

C9787

Q4272

Q4273

Q4274

Q4275

Q4276

Q4277

Q4278

Q4280

Q4281

Q4282

Q4283

Q4284

Procedure code C9786 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 notification if a proposed reimbursement rate will change or a procedure code will not be reimbursed because the expenditures are not approved.

Limitations

Procedure code J1440 will be restricted to diagnosis codes A0471 and A0472 and limited to clients who are 18 years of age or older.

Age limitations will apply for the following procedure codes:

Procedure Codes

Client Age Limitation

J1920, J1921

1 year of age or older

J1576

2 years of age or older

J9381

8 years of age or older

J7213

12 years of age or older

C9151, J0665, J1805, J1806, J1812, J1814, J1941, J1961, J2249, J2305, J2329, J2427, J2598, J2599, J9063, J9347, J9350, J9380

18 years of age or older

Second Quarter 2023 HCPCS Discontinued Procedure Codes

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

Procedure Codes

0053U

0143U

0144U

0145U

0146U

0147U

0148U

0149U

0150U

C9146

C9147

C9148

C9149

J2370

S0020

S0030

S0073

S0077

Discontinued procedure codes will not be reimbursed after June 30, 2023.

Second Quarter 2023 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes

0044A

0124A

0134A

0144A

0154A

0164A

0173A

91312

91313

91314

91315

91316

91317

J2426

Second Quarter 2023 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes

0387U

0388U

0389U

0390U

0391U

0392U

0393U

0394U

0395U

0396U

0397U

0398U

0399U

0400U

0401U

0791T

0792T

0793T

0794T

0795T

0796T

0797T

0798T

0799T

0800T

0801T

0802T

0803T

0804T

0805T

0806T

0807T

0808T

0809T

0810T

The description of the following informational procedure codes will be revised:

Procedure Codes

0022U

0308U

0356U

0357U

0358U

0359U

0360U

0361U

0362U

0363U

0364U

0365U

0366U

0367U

0368U

0369U

0370U

0371U

0372U

0373U

0374U

0375U

0376U

0377U

0378U

0379U

0380U

0381U

0382U

0383U

0384U

0385U

0386U

For more information, call the TMHP Contact Center at 800-925-9126.