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Third Quarter 2024 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 26, 2024, Texas Medicaid & Healthcare Partnership (TMHP) will implement the third quarter 2024 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after October 1, 2024. The HCPCS updates are detailed in this article.

Third Quarter 2024 HCPCS Added Procedure Codes

Clinician-Administered Drug (CAD) Procedure Codes
C9169C9170J0138
J1171J2252J2601
J8522J8541Q5135

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, 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 October 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

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

CAD Procedure Codes
C9171C9172J1749
J2002J2003J2004
J2253J9329Q5136
Non-CAD Procedure Codes
9062490684*A2027
A2028A2029A4543
A4544A4545A7021
A9610C8000E0469
E0683*E0715E0716
E0721E0737E0743
E0767E2513E3200
L1006L1653*L1821*
L8720L8721P9027*
Q0519Q0520Q4334
Q4335Q4336Q4337
Q4338Q4339Q4340
Q4341Q4342Q4343
Q4344Q4345 

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.

The following procedure codes will be added as benefits for Healthy Texas Women and the state-funded Family Planning Program:

Procedure Codes
90684J0138J2252
J2601  

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
L1653, L1821Birth through 20 years of age
Q5135Two years of age or older
C9169, C9170, J2601, J854118 years of age or older
9068419 years of age or older

Procedure codes L1653 and L1821 will require prior authorization. Refer to the current Texas Medicaid Provider Procedures Manual (TMPPM), Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.19.2, “Prior Authorization and Documentation Requirements,” for additional information.

Procedure code Q5135 will be restricted to the following diagnosis codes:

Diagnosis Codes
M0500M05011M05012M05019M05021M05022M05029
M05031M05032M05039M05041M05042M05049M05050
M05052M05059M05061M05062M05069M05071M05072
M05079M0509M0510M05111M05112M05119M05121
M05122M05129M05131M05132M05139M05141M05142
M05149M05151M05152M05159M05161M05162M05169
M05171M05172M05179M0519M0520M05211M05212
M05219M05221M05222M05229M05231M05232M05239
M05241M05242M05249M05251M05252M05259M05261
M05262M05269M05271M05272M05279M0259M0530
M05311M05312M05319M05321M05322M05329M05331
M05332M05339M05341M05342M05349M05351M05352
M05359M05361M05362M05369M05371M05372M05379
M0539M0540M05411M05412M05419M05421M05422
M05429M05431M05432M05439M05441M05442M05449
M05451M05452M05459M05461M05462M05469M05471
M05472M05479M0549M0550M05511M05512M05519
M05521M05522M05529M05531M05532M05539M05541
M05542M05549M05551M05552M05559M05561M05562
M05569M05571M05572M05579M0559M0560M05611
M05612M05619M05621M05622M05629M05631M05632
M05639M05641M05642M05649M05651M05652M05659
M05661M05662M05669M05671M05672M05679M0569
M0570M05711M05712M05719M05721M05722M05729
M05731M05732M05739M05741M05742M05749M05751
M05752M05759M05761M05762M05769M05771M05772
M05779M0579M057AM0580M05811M05812M05819
M05821M05822M05829M05831M05832M05839M05841
M05842M05849M05851M05852M05859M05861M05862
M05869M05871M05872M05879M0589M058AM059
M0600M06011M06012M06019M06021M06022M06029
M06031M06032M06039M06041M06042M06049M06051
M06052M06059M06061M06062M06069M06071M06072
M06079M0609M060AM0680M06811M06812M06819
M06821M06822M06829M06831M06832M06839M06841
M06842M06849M06851M06852M06859M06861M06862
M06869M06871M06872M06879M0689M068AM069
M0820M08211M08212M08219M08221M08222M08229
M08231M08232M08239M08241M08242M08249M08251
M08252M08259M08261M08262M08269M08271M08272
M08279M0829M082AM083M315M316 

Third Quarter 2024 HCPCS Discontinued Procedure Codes

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

Discontinued Procedure CodeDirect Replacement Procedure Code
C9150A9610
Discontinued Procedure Codes With No Direct Replacement
0078U0167U0396U
J1170J2001J8520
J8521J9258 

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

Third Quarter 2024 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
0248U0403U0472U
A2024A4271E0739
J2251J9172L1652
L1820Q0516Q0517
Q0518  

Note: Procedure code 0472U will be effective for dates of service on or after July 1, 2024, and procedure codes Q0516, Q0517, and Q0518 will be effective for dates of service on or after September 15, 2024.

Third Quarter 2024 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
0476U0477U0478U
0479U0480U0481U
0482U0483U0484U
0485U0486U0487U
0488U0489U0490U
0491U0492U0493U
0494U0495U0496U
0497U0498U0499U
0500U0501U0502U
0503U0504U0505U
0506U0507U0508U
0509U0510U0511U
0512U0513U0514U
0515U0516U0517U
0518U0519U0520U

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