Provider Alert! STAR Kids Long-Term Services and Supports Billing Matrix Revisions

Date: April 14, 2022

Attention: All Providers

Effective date: September 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.

TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied for other reasons.

Providers should direct questions to their Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org.

Call to action: The purpose of this communication is to inform providers of the upcoming STAR Kids long-term services and supports (LTSS) billing matrix revisions effective for September 1, 2022.

Background information: In 2019, the Health and Human Services Commission (HHSC) was directed by Centers for Medicare and Medicaid Services (CMS) to update the LTSS billing matrices to comply with the National Correct Coding Initiative (NCCI) by changing community-based LTSS billing in STAR Kids and STAR+PLUS from one hour to 15-minute billing units.

To review the matrix:
STAR Kids Appendix III Billing Matrix FINAL

How this impacts providers: Overall changes to the STAR Kids Billing Matrix includes the following:

• Removed CPT Codes
• Modifiers Defined in a legend and Updated
• Service Descriptions Updated
• Units verified with HPCP and updated
• Added Modifier U6 to all state plan services to designate a Medically Dependent Children Program (MDCP) member

Next steps for providers: TCHP will issue updated guidance on prior authorization requirements for our LTSS services with new code and modifier combinations soon so providers can prepare for the upcoming changes.

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.