Provider Alert! 2022 Healthcare Common Procedure Coding System (HCPCS) Update

Date: February 11, 2022

Attention: All Providers

Effective Date: January 1, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan (TCHP) aligns with the Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations that are implemented for claims processing by TMHP for Texas Medicaid. The one exception is, neurostimulators CPT Code 64585, will not require a prior authorization.

The 2022 Healthcare Common Procedure Coding System (HCPCS) updates that are effective for dates of service on or after January 1, 2022, are now available in the 2022 HCPCS Special Bulletin No. 21, posted on the Rate and Code Updates – HCPCS Updates page on tmhp.com. Deleted procedure codes are no longer benefits of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program. The Texas Medicaid Provider Procedures Manual and CSHCN Services Program Provider Manual will reflect the 2022 HCPCS changes in the February 2022 release.

How this impacts providers: A summary of the 2022 HCPCS updates can be found below and the complete list is available here.

• All new benefits except for 93319 are for lines of business (LOB)s Star, Star Kids, and CHIP and not a benefit for Chip-Perinate
  • Code 93319 is pregnancy related and considered also a benefit for Chip-Perinate
• All informational codes will be configured for all LOBs since these codes are only used for reporting and are not reimbursed
• All codes labeled “Not a Benefit” will be configured as non-payable for ALL LOBs
• All Discontinued codes will be termed out of the system effective 12/31/2021; these codes are expired and were deleted as an active code effective 1/1/2022

Prior authorization will be required for the following codes effective January 1, 2022:

• CPT Code 69716 for hearing devices- Implantation, Osseo integrated implant, skull; with magnetic transcutaneous attachment to external speech processor
• CPT Code 69719 for hearing devices- Revision or replacement (including removal of existing device), osseo integrated implant, skull; with magnetic transcutaneous attachment to external speech processor
• CPT Code Q2055 (replacement for C9081)- Idecabtagene vicleucel (ABECMA), up to 460 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose

Next steps for providers: Providers should share this communication with their billing staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.