On September 26, 2024, Texas Medicaid & Healthcare Partnership (TMHP) implemented 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
Effective October 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 | ||
---|---|---|
90624 | 90684* | A2027 |
A2028 | A2029 | A4543 |
A4544 | A4545 | A7021 |
A9610 | C8000 | C9169* |
C9170 | C9171 | C9172 |
E0469 | E0683* | E0715 |
E0716 | E0721 | E0737 |
E0743 | E0767 | E2513 |
E3200 | J0138* | J1171* |
J1749 | J2002 | J2003 |
J2004 | J2252* | J2253 |
J2601* | J8522* | J8541 |
J9329 | L1006 | L1653* |
L1821* | L8720 | L8721 |
P9027* | Q0519 | Q0520 |
Q5135* | Q5136 | Q4334 |
Q4335 | Q4336 | Q4337 |
Q4338 | Q4339 | Q4340 |
Q4341 | Q4342 | Q4343 |
Q4344 | Q4345 |
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 Codes | Client Age Limitation |
---|---|
L1653, L1821 | Birth through 20 years of age |
Q5135 | Two years of age or older |
C9169, J2601 | 18 years of age or older |
90684 | 19 years of age or older |
Procedure codes L1653 and L1821 will require prior authorization. Refer to the current CSHCN Services Program Provider Manual, subsection 28.3.1, “Prior Authorization and Documentation Requirements,” for additional information.
Procedure code Q5135 will be restricted to the following diagnosis codes:
Diagnosis Codes | ||||||
---|---|---|---|---|---|---|
M0500 | M05011 | M05012 | M05019 | M05021 | M05022 | M05029 |
M05031 | M05032 | M05039 | M05041 | M05042 | M05049 | M05050 |
M05052 | M05059 | M05061 | M05062 | M05069 | M05071 | M05072 |
M05079 | M0509 | M0510 | M05111 | M05112 | M05119 | M05121 |
M05122 | M05129 | M05131 | M05132 | M05139 | M05141 | M05142 |
M05149 | M05151 | M05152 | M05159 | M05161 | M05162 | M05169 |
M05171 | M05172 | M05179 | M0519 | M0520 | M05211 | M05212 |
M05219 | M05221 | M05222 | M05229 | M05231 | M05232 | M05239 |
M05241 | M05242 | M05249 | M05251 | M05252 | M05259 | M05261 |
M05262 | M05269 | M05271 | M05272 | M05279 | M0259 | M0530 |
M05311 | M05312 | M05319 | M05321 | M05322 | M05329 | M05331 |
M05332 | M05339 | M05341 | M05342 | M05349 | M05351 | M05352 |
M05359 | M05361 | M05362 | M05369 | M05371 | M05372 | M05379 |
M0539 | M0540 | M05411 | M05412 | M05419 | M05421 | M05422 |
M05429 | M05431 | M05432 | M05439 | M05441 | M05442 | M05449 |
M05451 | M05452 | M05459 | M05461 | M05462 | M05469 | M05471 |
M05472 | M05479 | M0549 | M0550 | M05511 | M05512 | M05519 |
M05521 | M05522 | M05529 | M05531 | M05532 | M05539 | M05541 |
M05542 | M05549 | M05551 | M05552 | M05559 | M05561 | M05562 |
M05569 | M05571 | M05572 | M05579 | M0559 | M0560 | M05611 |
M05612 | M05619 | M05621 | M05622 | M05629 | M05631 | M05632 |
M05639 | M05641 | M05642 | M05649 | M05651 | M05652 | M05659 |
M05661 | M05662 | M05669 | M05671 | M05672 | M05679 | M0569 |
M0570 | M05711 | M05712 | M05719 | M05721 | M05722 | M05729 |
M05731 | M05732 | M05739 | M05741 | M05742 | M05749 | M05751 |
M05752 | M05759 | M05761 | M05762 | M05769 | M05771 | M05772 |
M05779 | M0579 | M057A | M0580 | M05811 | M05812 | M05819 |
M05821 | M05822 | M05829 | M05831 | M05832 | M05839 | M05841 |
M05842 | M05849 | M05851 | M05852 | M05859 | M05861 | M05862 |
M05869 | M05871 | M05872 | M05879 | M0589 | M058A | M059 |
M0600 | M06011 | M06012 | M06019 | M06021 | M06022 | M06029 |
M06031 | M06032 | M06039 | M06041 | M06042 | M06049 | M06051 |
M06052 | M06059 | M06061 | M06062 | M06069 | M06071 | M06072 |
M06079 | M0609 | M060A | M0680 | M06811 | M06812 | M06819 |
M06821 | M06822 | M06829 | M06831 | M06832 | M06839 | M06841 |
M06842 | M06849 | M06851 | M06852 | M06859 | M06861 | M06862 |
M06869 | M06871 | M06872 | M06879 | M0689 | M068A | M069 |
M0820 | M08211 | M08212 | M08219 | M08221 | M08222 | M08229 |
M08231 | M08232 | M08239 | M08241 | M08242 | M08249 | M08251 |
M08252 | M08259 | M08261 | M08262 | M08269 | M08271 | M08272 |
M08279 | M0829 | M082A | M083 | M315 | M316 |
Third Quarter 2024 HCPCS Discontinued Procedure Codes
Effective October 1, 2024, CMS will discontinue the following procedure codes:
Discontinued Procedure Code | Direct Replacement Procedure Code |
---|---|
C9150 | A9610 |
Discontinued Procedure Codes With No Direct Replacement | ||
---|---|---|
0078U | 0167U | 0396U |
J1170 | J2001 | J8520 |
J8521 | J9258 |
Discontinued procedure codes will not be reimbursed after September 30, 2024.
Third Quarter 2024 HCPCS Revised Procedure Codes
The descriptions of the following procedure codes will be revised:
Procedure Codes | ||
---|---|---|
0248U | 0403U | 0472U |
A2024 | A4271 | E0739 |
J2251 | J9172 | L1652 |
L1820 | Q0516 | Q0517 |
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 | ||
---|---|---|
0476U | 0477U | 0478U |
0479U | 0480U | 0481U |
0482U | 0483U | 0484U |
0485U | 0486U | 0487U |
0488U | 0489U | 0490U |
0491U | 0492U | 0493U |
0494U | 0495U | 0496U |
0497U | 0498U | 0499U |
0500U | 0501U | 0502U |
0503U | 0504U | 0505U |
0506U | 0507U | 0508U |
0509U | 0510U | 0511U |
0512U | 0513U | 0514U |
0515U | 0516U | 0517U |
0518U | 0519U | 0520U |
For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.