Provider Alert! First Quarter 2022 HCPCS Updates for Texas Medicaid 

Date: July 5, 2022

Attention: Providers

Effective Date: April 1, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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: On March 24, 2022, Texas Medicaid and Healthcare Partnership (TMHP) implemented the first quarter 2022 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2022.

How this impacts providers:

First Quarter 2022 HCPCS Added Procedure Codes

Clinician Administered Drug (CAD) Procedure Codes
C9093	J0219	J0491
J9071	J9273	J9359

Reminder: The clinician administered drug 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, 2022. Claims will be denied 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, 2022, published rate until the HHSC rate hearing is held, as required by 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

Effective April 1, 2022, the following procedure codes will be added as noncovered procedure codes for Texas Medicaid:

CAD Procedure Codes
C9090	C9091	C9092
J0879	Q5124

 

Non-CAD Procedure Codes
A2011	A2012	A2013
A4100	A4238	A9291
A9574	C9781	C9782
C9783	E2102	H2038
K1028	K1029	K1030*
K1031	K1032	K1033
Q4224	Q4225	Q4256
Q4257	Q4258	T2050
T2051	V2525

Procedure codes noted with an asterisk in the table above will require a Texas Medicaid rate hearing.

Limitations

Age limitations will apply for the following procedure codes:

Procedure Codes	Client Age Limitation
J9273, J9359	18 years of age or older

Procedure code J0219 will be limited to clients who are 1 year of age or older and will require prior authorization.

Refer to: The current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 7.27.1, “Prior Authorization,” for enzyme replacement therapy prior authorization requirements.

Procedure code J0491 will be limited to clients who are 18 years of age or older and will require prior authorization.

Refer to: The current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 7.51, “Lupus Treatment Agents,” for prior authorization requirements for initial requests and recertifications or extensions.

First Quarter 2022 HCPCS Discontinued Procedure Codes

Effective April 1, 2022, CMS will discontinue the following procedure codes:

Discontinued Procedure Codes
0097U	0151U	C9084
C9085	C9086	C9087
G1009	M1145

Discontinued procedure codes will not be reimbursed after March 31, 2022.

First Quarter 2022 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

Procedure Codes
0306U	0307U	0308U
0309U	0310U	0311U
0312U	0313U	0314U
0315U	0316U	0317U
0318U	0319U	0320U
0321U	0322U

The descriptions of procedure codes 0022U and 3022F will be revised.

First Quarter 2022 HCPCS Modifier Updates

Modifier	Action
93	ADD
FT	REVISE DESCRIPTION

 

Next steps for providers: Prescribers should adjust their prescribing patterns accordingly and share this update with their 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.