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Third 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 September 28, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) implemented the third quarter 2023 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after October 1, 2023. The HCPCS updates are detailed in this article.

Third Quarter 2023 HCPCS Added Procedure Codes

Clinician-Administered Drug (CAD) Procedure Codes
C9152C9153C9154
C9155C9157C9158
J0801J0802J2359
J2781J7214J7519
J9051J9345 

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, October 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 October 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

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

CAD Procedure Codes
J0349J0874J7353
J9064  
Non-CAD Procedure Codes
A2022A2023A2024
A2025A9156A9268
A9269A9292 A9573
A9603A9697B4148
C9156C9788C9789
C9790C9791C9792
E0490E0491H2040
H2041J0889K1036
L1681L5991Q4285
Q4286V2526 

Additional Benefit Information

Medication-assisted treatment procedure code C9154 may be separately reimbursed from withdrawal management and treatment services in the outpatient or residential setting.

The following procedure codes will be restricted to clients who are 18 years of age or older:

Procedure Codes
C9152C9153C9155
C9158J2781J9345

Tofersen (procedure code C9157) will be restricted to diagnosis code G1221 and limited to clients who are 18 years of age or older.

Mycophenolate mofetil (procedure code J7519) may be indicated for but is not limited to treatment for prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants.

Third Quarter 2023 HCPCS Discontinued Procedure Codes

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

Procedure Codes
0066U0357U0386U
0397UJ0800C9151

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

Third Quarter 2023 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
91304A4344J1921
K1004K1028 

Note: Procedure code 91304 will be effective for dates of service on or after August 14, 2023.

Third Quarter 2023 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
0019M0402U0403U
0404U0405U0406U
0407U0408U0409U
0410U0411U0412U
0413U0414U0415U
0416U0417U0418U
0419U  

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

Procedure Codes
0269U0271U0272U
0274U0277U0278U

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