Second Quarter 2022 HCPCS Updates for Texas Medicaid
Date: July 27, 2022Attention: All ProvidersEffective Date: July 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: 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:
HCPCS
Drug Name
C9094
Sutimlimab-jome
C9095
Tebentafusp-tebn
C9096
Filgrastim-ayow (Releuko)
C9097
Faricimab-svoa
J0739
Cabotegravir
J1306
Inclisiran
J1551
Immune globulin (cutaquig)
J2779
Ranibizumab, via intravitreal implant (susvimo)
J2998
Plasminogen tvmh 1mg
J3299
Triamcinolone acetonide (xipere)
J9331
Injection, sirolimus protein-bound particles
J9332
Injection, efgartigimod alfa-fcab
C9098
Ciltacabtagene autoleucel
Age limitations will apply for the following procedure codes:
Procedure Codes
Client Age Limitation
C9094, C9095, J1306, J9331
18 years of age or older
J0739
10 years of age or older
J1551
2 years of age or older
J2356
12 years of age or older
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.