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First 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 March 28, 2024, Texas Medicaid & Healthcare Partnership (TMHP) implemented the first quarter 2024 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which are effective for dates of service on or after April 1, 2024. The HCPCS updates are detailed in this article.

First Quarter 2024 HCPCS Added Procedure Codes

Clinician-Administered Drug (CAD) Procedure Codes
C9166C9167C9168
J0177J0577J0578
J0650J0651J0652
J1010J1202J1203
J1323J2277J2782
J2919J3055J7165
J7354J9073J9075

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, April 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 April 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

The following procedure code will be added as a Healthy Texas Women (HTW) benefit:

CAD Procedure Code
J7354  

The following procedure codes will be added as HTW Plus benefits:

CAD Procedure Codes
J0577J0578 

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

CAD Procedure Codes
J0209J0589J1434
J2801J3424J9074
J9248J9249J9376
Q5133Q5134 
Non-CAD Procedure Codes
A2026A4271A4438*
A4564*A4593A4594
A9293C9796C9797
E0152E0468E0736*
E0738E0739E2104
G0138*H0051K1037
L1320*L5783L5841*
Q4305Q4306Q4307
Q4308Q4309Q4310
S4988S9002 

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.

Procedure code E2298 will be a benefit of Texas Medicaid and will not require a rate hearing.

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
E0736, J1202, J1203, J1323, J3055, J716518 years of age or older

Procedure code A4438 will be limited to clients who are 18 years of age or older with a purchased device and claims history of a neuromuscular electrical stimulation or transcutaneous electrical nerve stimulation procedure within the last five years.

Procedure code E2298 will require prior authorization and be limited to one purchase per five years. Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.17.15, “Power Seat Elevation System,” for additional information about prior authorization criteria.

Procedure code G0138 must be billed with procedure code J1203 on the same day by the same provider. Procedure code J1203 must be billed with procedure code J1202 on the same day by the same provider.

Procedure code J7354 will be restricted to diagnosis code B081 and limited to clients who are 2 years of age or older.

Procedure code L1320 will require prior authorization and be limited to clients who are birth through 20 years of age. Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.19.2, “Prior Authorization and Documentation Requirements,” for additional information about prior authorization criteria.

Procedure code L5841 will require prior authorization and be limited to clients who are birth through 20 years of age. Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.20.2.1, “Lower-Limb Prostheses,” for additional information about prior authorization criteria.

Procedure code C9166 will be limited to clients who are 2 years of age or older and restricted to the following diagnosis codes:

Diagnosis Codes
L400L401L402
L403L404L405
L4050L4051L4052
L4053L4054L4059
L408L409M0880
M450M451M452
M453M454M455
M456M457M458
M459M4680M4681
M4682M4683M4684
M4685M4686M4687
M4688M4689 

Procedure code C9168 will be limited to clients who are 18 years of age or older and restricted to the following diagnosis codes:

Diagnosis Codes
K5100K51011K51012
K51013K51014K51018
K51019K5120K51211
K51212K51213K51214
K51218K51219K5130
K51311K51312K51313
K51314K51318K51319
K5180K51811K51812
K51813K51814K51818
K51819K5190K51911
K51912K51913K51914
K51918K51919 

First Quarter 2024 HCPCS Discontinued Procedure Codes

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

Discontinued Procedure CodesDirect Replacement Procedure Codes
C9159J7165
C9160J0589
C9161J0177
C9162J2782
C9163J3055
C9164J7354
C9165J1323
E2300E2298
J0576J0577, J0578
J1020J1010
J2920J2919
J9070J9075
Discontinued Procedure Codes with No Direct Replacement
0354U0416UJ1030
J1040J1840J1850
J2930J9250Q4244

Discontinued procedure codes will not be reimbursed after March 31, 2024.

First Quarter 2024 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Procedure Codes
1066F2060F3455F
A4561A4562E2001
J0208J0612J0613
J3380J3425J7516
J9029J9255J9260

Note: Procedure codes 1066F, 2060F, and 3455F will be effective for dates of service on or after January 1, 2024.

First Quarter 2024 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
0439U0440U0441U
0442U0443U0444U
0445U0446U0447U
0448U0449U 

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