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 | |||||||||
---|---|---|---|---|---|---|---|---|---|
E0658 | E0659 | J0163 | J0164 | J0458 | J0525 | J0570 | J0582 | J0668 | J0738 |
J0752 | J0759 | J1834 | J2151 | J2291 | J3290 | J9011 | L1007 | L6034 |
Effective October 1, 2025, the CSHCN Services Program will add the following procedure codes as noncovered procedure codes:
Procedure Codes | |||||||||
---|---|---|---|---|---|---|---|---|---|
A2036 | A2037 | A2038 | A2039 | A4288 | A9612 | A9616 | C1740 | C1741 | C1742 |
C9305 | C9306 | E0150 | J0462 | J0614 | J0675 | J0681 | J1370 | J1612 | J1807 |
J1809 | J3402 | J3403 | J7173 | J7174 | L5657 | L6035 | L6036 | L6038 | L6039 |
Q4383 | Q4384 | Q4385 | Q4386 | Q4387 | Q4388 | Q4389 | Q4390 | Q4391 | Q4392 |
Q4393 | Q4394 | Q4395 | Q4396 | Q4397 | Q5154 | Q5155 | Q5156 | Q5157 | Q5158 |
Q5159 |
The following procedure codes are not benefits because they are considered part of another service:
Procedure Codes | |||||||||
---|---|---|---|---|---|---|---|---|---|
A2036 | A2037 | A2038 | A2039 | A9612 | A9616 | C1741 | Q4383 | Q4384 | Q4385 |
Q4386 | Q4387 | Q4388 | Q4389 | Q4390 | Q4391 | Q4392 | Q4393 | Q4394 | Q4395 |
Q4396 | Q4397 |
Additional Benefit Information
Age limitations will apply for the following procedure codes:
Procedure Codes | Client Age Limitation |
---|---|
E0658, E0659, J0164, J0458, J0668, J9011 | 18 years of age or older |
J0570 | 16 years of age or older |
J0738, J0752 | 15 years of age or older |
L1007 | Birth 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 Codes | Direct Replacement Procedure Codes |
---|---|
C9088 | J0668 |
C9174 | J9011 |
J2150 | J2151 |
Discontinued Procedure Codes With No Direct Replacement | |||||||||
---|---|---|---|---|---|---|---|---|---|
0450U | 0451U | C9175 | C9248 | J2503 | S0074 |
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 | |||||||||
---|---|---|---|---|---|---|---|---|---|
90612 | 90613 | 90635 | 91323 | C1739 | C1982 | E0765 | E0986 | J1961 | J7300 |
J9072 | J9333 | L5673 | L5679 | L5783 | L6028 | L7406 |
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 | |||||||||
---|---|---|---|---|---|---|---|---|---|
0575U | 0576U | 0577U | 0578U | 0579U | 0580U | 0581U | 0582U | 0583U | 0584U |
0585U | 0586U | 0587U | 0588U | 0589U | 0590U | 0591U | 0592U | 0593U | 0594U |
0595U | 0596U | 0597U | 0598U | 0599U | C8006 | M0235 | M0236 | M0237 | M0238 |
Q0235 | Q0237 |
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 | |||||||||
---|---|---|---|---|---|---|---|---|---|
0285U | 0552U | 0553U | 0554U | 0555U | 0556U | 0557U | 0558U | 0559U | 0560U |
0561U | 0562U | 0563U | 0564U | 0565U | 0566U | 0567U | 0568U | 0569U | 0570U |
0571U | 0572U | 0573U | 0574U |
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 | |||||||||
---|---|---|---|---|---|---|---|---|---|
90382 | 90624 | C9807 | C9808 | J0166 | J0167 | J0169 | J0901 | J9341 | Q5136 |
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 Codes | Client Age Limitation |
---|---|
90382 | Birth through 7 months of age |
90624 | 10 through 23 years of age |
J0901, J9341 | 18 years of age or older |
Q5136 | 12 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.