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First Quarter 2022 HCPCS Updates for Texas Medicaid 

Date: July 5, 2022Attention: ProvidersEffective Date: April 1, 2022Providers 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   
C9093J0219J0491
J9071J9273J9359
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   
C9090C9091C9092
J0879Q5124 
 
Non-CAD Procedure Codes  
A2011A2012A2013
A4100A4238A9291
A9574C9781C9782
C9783E2102H2038
K1028K1029K1030*
K1031K1032K1033
Q4224Q4225Q4256
Q4257Q4258T2050
T2051V2525 
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 CodesClient Age Limitation
J9273, J935918 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  
0097U0151UC9084
C9085C9086C9087
G1009M1145 
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  
0306U0307U0308U
0309U0310U0311U
0312U0313U0314U
0315U0316U0317U
0318U0319U0320U
0321U0322U 
The descriptions of procedure codes 0022U and 3022F will be revised. First Quarter 2022 HCPCS Modifier Updates
ModifierAction
93ADD
FTREVISE 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.