Tag - Procedure Codes

Provider Alert!
12Jun

Provider Alert! Maximum Allowable Update for Non-Risk Based Drugs Billed With ‘Unclassified’ Procedure Codes

Date: June 12, 2024 Attention: All Providers Call to action: The Texas Health and Human Services Commission (HHSC) would like to disclose the maximum allowable reimbursement for Non-Risk drugs currently payable under an ‘Unclassified’ procedure code as referenced in the National Drug Code to Healthcare Common Procedure Coding System (NDC to HCPCS) crosswalk. How this impacts providers: HHSC bases the pricing for an outpatient medical claim for an ‘Unclassified’ procedure code on the lesser of the manufacturer’s suggested retail price minus 18% or...

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Provider Alert!
02May

Provider Alert! First Quarter 2024 HCPCS

Date: May 2, 2024 Attention: All Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that Texas Medicaid & Healthcare Partnership (TMHP) implemented the first quarter 2024 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2024. How this impacts providers: The following drug procedure codes will be added as Medicaid benefits effective April 1, 2024: First Quarter 2024 HCPCS Added...

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Provider Alert!
01Feb

Provider Alert! Provider Type and Places of Service Update for Procedure Code 96372

Date: February 1, 2024 Attention: All Providers Effective date: January 1, 2024 Call to action: Texas Children’s Health plan (TCHP) would like to make providers aware that effective for dates of service on or after January 1, 2024, injectable medication administration procedure code 96372 may be reimbursed to Texas Health Steps medical providers for services rendered in the office, outpatient hospital and birthing center settings. Next step for Providers: Providers are not required to appeal the claims unless they are denied for additional reasons...

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Provider Alert!
08Nov

Provider Alert! COVID-19 Vaccine and Vaccine Administration Procedure Codes 91318, 91319, 91320, 91321, 91322, and 90480 Are Now Benefits of Medicaid and CHIP

Date: November 7, 2023 Attention: All Providers Effective for dates of service on or after September 11, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that in accordance with the U.S. Food and Drug Administration’s amended Emergency Use Authorizations COVID-19 vaccine administration codes for the Pfizer-BioNTech and Moderna COVID-19 vaccines, vaccine procedure codes 91318, 91319, 91320, 91321, 91322, and vaccine administration procedure code 90480 are benefits for Medicaid and CHIP. How this impacts providers: The procedure codes are...

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Provider Alert!
07Jul

Provider Alert! Noninvasive Prenatal Screening Benefits to Change for Texas Medicaid July 1, 2023

Date: July 7, 2023 Attention: All Providers Effective Date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective July 1, 2023, noninvasive prenatal screening (NIPS) benefits will change for Texas Medicaid. How this impacts providers: Effective July 1, 2023, major changes to this medical benefit include the following: Updated benefit eligibility criteria Removed fee-for-service (FFS) prior authorization requirement NIPS is a benefit for members who have a confirmed intrauterine singleton pregnancy dated at least ten weeks gestation. Members...

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Provider Alert!
15Feb

Provider Alert! Reimbursement Update for Procedure Codes Pending a Rate Hearing

Date: February 14, 2023  Attention: All Providers Effective date: May 8, 2023 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: Beginning May 8, 2023, TCHP will follow the Texas Medicaid Provider Procedures Manual (TMPPM) guidance regarding claims and the procedure codes that are pending a rate...

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Provider Alert!
25Jan

Provider Alert! Update to Age Restrictions for Vaccine Procedure Codes 90671 (Vaxneuvance) and 90756 (Flucelvax Quadrivalent)

Date: January 23, 2023 Attention: Providers Effective date: February 1, 2023 for dates of service on or after December 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: The Food and Drug Administration has expanded the age limitations for the following vaccines: Vaxneuvance™ (pneumococcal 15-valent conjugate...

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17Oct

Provider Alert! COVID-19 Procedure Code Updates for Second Quarter 2022 HCPCS

Date: October 12, 2022 Attention: All Providers Effective Date: June 23, 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 Health Plan (TCHP) would like to inform providers that on June 23, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) implemented the second...

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08Aug

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A Are Now Benefits of Texas Medicaid and CHIP

Date: August 8, 2022 Attention: All Providers Effective Date: June 17, 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) would like to inform providers that effective for dates of service on or after June 17, 2022, COVID-19 vaccine administration procedure codes...

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08Aug

Provider Alert! Moderna COVID-19 Vaccine Administration Procedure Codes 0011A, 0012A, and 0013A Age Expansion for Medicaid and CHIP

Date: August 5, 2022 Attention: All Providers Effective Dates: June 17, 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) would like to inform providers that effective for dates of service on or after June 17, 2022, in accordance with the U.S. Food...

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