Subcutaneous Internal Cardiac Defibrillator (S-ICD) to Become a Benefit for Texas Medicaid

Date: August 25, 2021 Attention: Cardiologists Effective Date: September 1, 2021Providers 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: Effective September 1, 2021, subcutaneous internal cardiac defibrillator (S-ICD) procedure codes 33270, 33271, 33273, 33274, 93287, and 93290 will become a benefit for Texas Medicaid. How this impacts providers: Insertion or Replacement Services Procedure codes 33270 (insertion or replacement) and 33271 (insertion) can be reimbursed as follows:

• To physician providers for services rendered in the inpatient and outpatient hospital settings
• To ambulatory surgical center providers for services rendered in the outpatient hospital setting

Removal Services Procedure code 33272 for removal can be reimbursed to physician providers for services rendered in the inpatient and outpatient hospital settings. Repositioning Services Procedure code 33273 for repositioning can be reimbursed as follows:

• To physician providers for services rendered in the inpatient and outpatient hospital settings
• To ambulatory surgical center providers for services rendered in the outpatient hospital setting

Peri-Procedural and Interrogation Device Evaluation Services Procedure codes 93287 and 93290 for peri-procedural and interrogation device evaluation services can be reimbursed as follows:

• The total component can be reimbursed to physician assistant (PA), nurse practitioner (NP), and clinical nurse specialist (CNS) providers for services rendered in the office, inpatient and outpatient settings.
• The professional component can be reimbursed to PA, NP, CNS, and physician providers for services rendered in the office, inpatient and outpatient settings.
• The technical component can be reimbursed:
• To physician, PA, NP, CNS, portable X-ray supplier, radiological lab, and physiological lab providers for services rendered in the office setting.
• To hospital providers for services rendered in the outpatient hospital setting.

Next steps for providers: Providers should 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.