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New Procedure Codes for Diaphragm-Pacing Neuromuscular Stimulation Effective January 1, 2024

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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 January 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the 2024 Healthcare Common Procedure Coding System (HCPCS) updates. This will include the following procedure codes for diaphragm-pacing neuromuscular stimulation implantation that are effective for dates of service on or after January 1, 2024:

Procedure Codes
332763327733278332793328033281
3328733288931509315193153 

The above procedure codes may be reimbursed with prior authorization when submitted with the following diagnosis codes:

Diagnosis Codes
G1220G1222G1223G1224G1225G1229
G128G129G4735G8250G8251G8252
G8253G8254G8389J9610J9611J9612
J9620J9621J9622R0681Z9911 

Providers can find more information in the Texas Medicaid Provider Procedures Manual (TMPPM), Medical and Nursing Specialists, Physicians, and Physicians Assistants Handbook, subsection 9.2.44.6, “Diaphragm-Pacing Neuromuscular Stimulation.”

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