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.