Skip to main content

Second Quarter 2024 HCPCS Updates for the CSHCN Services Program

Last updated on

On June 27, 2024, Texas Medicaid & Healthcare Partnership (TMHP) will implement the second quarter 2024 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2024. The HCPCS updates are detailed in this article.

Second Quarter 2024 HCPCS Added Procedure Codes

Effective July 1, 2024, the following procedure codes will be added as noncovered procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program:

Procedure Codes
9063790638A9506
C1605C1606C9901
G0519G0520G0521
G0522G0523G0524
G0525G0526G0527
G0528G0529G0530
G0531G9037G9038
J0211J0687*J0872*
J0911J1597*J1598*
J1748*J2183*J2246
J2267J2373*J2468
J2470*J2471*J3247*
J3263J3393J3394
J7171J7355J8611*
J8612J9361M0224
Q0224Q4311Q4312
Q4313Q4314Q4315
Q4316Q4317Q4318
Q4319Q4320Q4321
Q4322Q4323Q4324
Q4325Q4326Q4327
Q4328Q4329Q4330
Q4331Q4332Q4333
Q5137Q5138 

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.

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
J2373, J8611 18 years of age or older

Procedure code J1748 will be limited to clients who are 18 years of age or older and restricted to the following diagnosis codes:

Diagnosis Codes
K5000K50011K50012
K50013K50014K50018
K50019K5010K50111
K50112K50113K50114
K50118K5080K50811
K50812K50813K50814
K50818K50819K5090
K50911K50912K50913
K50914K50918K5100
K51011K51012K51013
K51014K51018K51019
K5120K51211K51212
K51213K51214K51218
K5130K51311K51312
K51313K51314K51318
K5180K51811K51812
K51813K51814K51818
K5190K51911K51912
K51913K51914K51918
K51919  

Procedure code J3247 will be limited to clients who are 18 years of age or older and restricted to the following diagnosis codes:

Diagnosis Codes
L400L401L402
L403L404L4050
L4051L4052L4053
L4054L4059L408
L409M0880M450
M451M452M453
M454M455M456
M457M458M459
M4680M4681M4682
M4683M4684M4685
M4686M4687M4688
M4689  

Second Quarter 2024 HCPCS Discontinued Procedure Codes

Effective July 1, 2024, CMS will discontinue the following procedure codes:

Discontinued Procedure CodesDirect Replacement Procedure Codes
C9113J2471
C9166J3247
C9167J7171
C9168J2267
Discontinued Procedure Codes with No Direct Replacement
0204U0353UJ2780
J9371Q4210Q4277
S0164  

Discontinued procedure codes will not be reimbursed after June 30, 2024.

Second Quarter 2024 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
J0134J0136J0137
J0173J0401J0651
J0652J0873J0893
J1574J1806J1921
J2021J2184J2251
J2272J2281J2599
J2806J3244J3371
J3372J9046J9172
J9258J9259J9294
J9296J9314J9322
J9393Q2055 

Second Quarter 2024 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
0450U0451U0452U
0453U0454U0455U
0456U0457U0458U
0459U0460U0461U
0462U0463U0464U
0465U0466U0467U
0468U0469U0470U
0471U0472U0473U
0474U0475U0867T
0868T0869T0870T
0871T0872T0873T
0874T0875T0876T
0877T0878T0879T
0880T0881T0882T
0883T0884T0885T
0886T0887T0888T
0889T0890T0891T
0892T0893T0894T
0895T0896T0897T
0898T0899T0900T

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