Skip to main content

Second Quarter 2024 HCPCS Updates for Texas Medicaid

Last updated on

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 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

Clinician-Administered Drug (CAD) Procedure Codes
J0687J0872J1597
J1598J1748J2183
J2267J2373J2470
J2471J3247J3263
J3393J7171J7355
J8611J8612 

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, 2024. 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, 2024, 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 code will be added as a Healthy Texas Women (HTW) benefit:

CAD Procedure Code
J0687  

Effective July 1, 2024, the following procedure codes will be added as noncovered procedure codes for Texas Medicaid:

CAD Procedure Codes
J0211J0911J2246
J2468J3394J9361
Q5137Q5138 
Non-CAD Procedure Codes
9063790638A9506
C1605C1606C9901
G0519G0520G0521
G0522G0523G0524
G0525G0526G0527
G0528G0529G0530
G0531G9037G9038
M0224*Q0224*Q4311
Q4312Q4313Q4314
Q4315Q4316Q4317
Q4318Q4319Q4320
Q4321Q4322Q4323
Q4324Q4325Q4326
Q4327Q4328Q4329
Q4330Q4331Q4332
Q4333  

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.

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.

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
J2373, J3263, J7355, J861118 years of age or older
J861218 years of age or younger
M0224, Q022412 years of age or older

Procedure code J2267 is a replacement for discontinued procedure code C9168 and will have the same diagnosis restrictions. Refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.84, “Mirikizumab-mrkz,” for a list of payable diagnosis codes.

Procedure code J3247 is a replacement for discontinued procedure code C9166 and will have the same diagnosis restrictions. Refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.107, “Secukinumab (Cosentyx),” for a list of payable diagnosis codes.

Betibeglogene autotemcel (Zynteglo) procedure code J3393 will require prior authorization and be limited to clients who are 4 years of age or older. Refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.16, “Betibeglogene autotemcel (Zynteglo),” for additional benefit information and prior authorization criteria.

Procedure code J7171 is a replacement for discontinued procedure code C9167 and will have the same prior authorization requirements. Refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.42.2, “Prior Authorization,” for the prior authorization requirements.

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  

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 Contact Center at 800-925-9126.