Provider Alert! Second Quarter 2022 HCPCS Updates for Texas Medicaid

Date: July 27, 2022

Attention: All Providers

Effective Date: July 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: Texas Children’s Health Plan (TCHP) would like to inform providers that Texas Medicaid & Healthcare Partnership (TMHP) implemented the second quarter 2022 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2022.

How this impacts providers: The following drug procedure codes will be added as Medicaid benefits effective July 1 2022:

Age limitations will apply for the following procedure codes:

• Procedure code C9096, which is a granulocyte colony stimulating factor, will be restricted by diagnosis.
• Refer to subsection 6.23, “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim),” in the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook for a list of payable diagnosis codes for colony stimulating factors.
• Procedure code J2356 will be restricted to diagnosis codes J4550 and J4551 for dates of service from July 1, 2022, through July 31, 2022.
• Procedure code J2998 will be restricted to diagnosis code E8802.
• Procedure code J9332 will be limited to clients who are 18 years of age or older and restricted to diagnosis codes G700 and G7001.

Next steps for providers: Providers are encouraged to share this communication 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