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Third Quarter 2025 HCPCS Updates for the CSHCN Services Program

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On October 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the third quarter 2025 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after October 1, 2025. This article details the HCPCS updates.

Third Quarter 2025 HCPCS Added Procedure Codes

All new benefits must go through the Texas Medicaid rate hearing process to allow public comment on proposed reimbursement rates. The Children with Special Health Care Needs (CSHCN) Services Program must review the adopted Texas Medicaid rates to determine whether they are fiscally feasible for the program.

Note: The CSHCN Services Program may adopt temporary or interim rates for procedure codes before the rate hearing process is complete. TMHP will deny any claims until they’ve implemented a rate or an interim rate for a procedure code. After the rate is implemented, TMHP may process any affected claims according to the Centers for Medicare & Medicaid Services (CMS) effective date.

After the rate hearing, the CSHCN Services Program must approve the expenditures before the rates can be adopted. TMHP will notify providers in a future article if a proposed reimbursement rate will change or if claims for a procedure code will not be reimbursed because the expenditures are not approved.

The CSHCN Services Program will add the following procedure codes as benefits pending the required Texas Medicaid rate hearing:

Procedure Codes
E0658E0659J0163J0164J0458J0525J0570J0582J0668J0738
J0752J0759J1834J2151J2291J3290J9011L1007L6034 

Effective October 1, 2025, the CSHCN Services Program will add the following procedure codes as noncovered procedure codes:

Procedure Codes
A2036A2037A2038A2039A4288A9612A9616C1740C1741C1742
C9305C9306E0150J0462J0614J0675J0681J1370J1612J1807
J1809J3402J3403J7173J7174L5657L6035L6036L6038L6039
Q4383Q4384Q4385Q4386Q4387Q4388Q4389Q4390Q4391Q4392
Q4393Q4394Q4395Q4396Q4397Q5154Q5155Q5156Q5157Q5158
Q5159         

The following procedure codes are not benefits because they are considered part of another service:

Procedure Codes
A2036A2037A2038A2039A9612A9616C1741Q4383Q4384Q4385
Q4386Q4387Q4388Q4389Q4390Q4391Q4392Q4393Q4394Q4395
Q4396Q4397        

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
E0658, E0659, J0164, J0458, J0668, J901118 years of age or older
J057016 years of age or older
J0738, J075215 years of age or older
L1007Birth through 20 years of age

Procedure codes E0658 and E0659 will be restricted to diagnosis codes I890, I898, I972, and Q820.

Mannitol (procedure code J2151), when used for the treatment of end-stage renal disease or acute kidney injury, will be included in the composite rate payment, and claims will not be reimbursed separately.

Procedure code L1007 will require prior authorization. Refer to the current CSHCN Services Program Provider Manual, “Orthotic and Prosthetic Devices,” subsection 28.3.1, “Prior Authorization and Documentation Requirements,” for additional information. Claims for procedure codes L1007 and L0634 will not both be reimbursed when submitted for the same day by the same provider.

Procedure code L6034 will require prior authorization. Refer to the current CSHCN Services Program Provider Manual, “Orthotic and Prosthetic Devices,” subsection 28.4.1, “Prior Authorization and Documentation Requirements,” for additional information.

Third Quarter 2025 HCPCS Discontinued Procedure Codes

Effective October 1, 2025, CMS will discontinue the following procedure codes:

Discontinued Procedure CodesDirect Replacement Procedure Codes
C9088J0668
C9174J9011
J2150J2151
Discontinued Procedure Codes With No Direct Replacement
0450U0451UC9175C9248J2503S0074    

Claims for discontinued procedure codes will not be reimbursed after September 30, 2025.

Third Quarter 2025 HCPCS Revised Procedure Codes

CMS will revise the descriptions of the following procedure codes:

Procedure Codes
90612906139063591323C1739C1982E0765E0986J1961J7300
J9072J9333L5673L5679L5783L6028L7406   

Note: The revised description for procedure code J1961 will be effective for dates of service on or after June 18, 2025.

Third Quarter 2025 HCPCS Informational Procedure Codes

The CSHCN Services Program will add the following procedure codes as informational only:

Procedure Codes
0575U0576U0577U0578U0579U0580U0581U0582U0583U0584U
0585U0586U0587U0588U0589U0590U0591U0592U0593U0594U
0595U0596U0597U0598U0599UC8006M0235M0236M0237M0238
Q0235Q0237        

Note: Procedure codes M0237, M0238, and Q0237 will be effective for dates of service on or after January 24, 2025.

CMS will revise the descriptions of the following informational procedure codes:

Procedure Codes
0285U0552U0553U0554U0555U0556U0557U0558U0559U0560U
0561U0562U0563U0564U0565U0566U0567U0568U0569U0570U
0571U0572U0573U0574U      

Updates for Procedure Codes From a Previous Quarter

The CSHCN Services Program will add the following procedure codes as benefits, pending a required rate hearing:

Procedure Codes
9038290624C9807C9808J0166J0167J0169J0901J9341Q5136
Q5151         

Note: Procedure code 90382 will be effective for dates of service on or after July 1, 2025, and procedure code 90624 will be effective for dates of service on or after June 25, 2025.

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
90382Birth through 7 months of age
9062410 through 23 years of age
J0901, J934118 years of age or older
Q513612 years of age or older

Procedure code J0901 will be restricted to diagnosis codes D631 and N186.

Procedure code Q5151 will be restricted to diagnosis codes D5932, D5939, D595, G7000, and G7001.

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