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Certain Non-Surgical Services Procedure Codes No Longer Reimbursed Separately for HASC and ASC Providers

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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.

Effective for dates of service on or after December 1, 2024, certain non-surgical services procedure codes will no longer be reimbursed separately for hospital-based ambulatory surgery centers (HASC) and ambulatory surgery centers (ASC) because they are included in the Medicare ASC global payment. This change applies to Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

The following non-surgical services procedure codes will be affected under this change:

Procedure Codes
L8614L8625L8630L8631L8641L8642L8658
L8659L8678L8680L8681L8682L8683L8684
L8685L8686L8687L8688L8689L8690L8691
L8692L8693L8694L8695P9010P9011P9025
P9031P9032P9033P9034P9035P9036P9037
P9038P9039P9040P9041P9043P9044P9045
P9046P9047P9048P9050P9051P9052P9053
P9054P9055P9056P9057P9058P9059P9060
P9099Q0507Q0508V2790   

 Note: The HASC’s and ASC’s Static Fee schedule will be updated to reflect these changes.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.