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 | | |
| C9093 | J0219 | J0491 |
| J9071 | J9273 | J9359 |
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 | | |
| C9090 | C9091 | C9092 |
| J0879 | Q5124 | |
| Non-CAD Procedure Codes | | |
| A2011 | A2012 | A2013 |
| A4100 | A4238 | A9291 |
| A9574 | C9781 | C9782 |
| C9783 | E2102 | H2038 |
| K1028 | K1029 | K1030* |
| K1031 | K1032 | K1033 |
| Q4224 | Q4225 | Q4256 |
| Q4257 | Q4258 | T2050 |
| T2051 | V2525 | |
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 Codes | Client Age Limitation |
| J9273, J9359 | 18 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 | | |
| 0097U | 0151U | C9084 |
| C9085 | C9086 | C9087 |
| G1009 | M1145 | |
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 | | |
| 0306U | 0307U | 0308U |
| 0309U | 0310U | 0311U |
| 0312U | 0313U | 0314U |
| 0315U | 0316U | 0317U |
| 0318U | 0319U | 0320U |
| 0321U | 0322U | |
The descriptions of procedure codes 0022U and 3022F will be revised.
First Quarter 2022 HCPCS Modifier Updates| Modifier | Action |
| 93 | ADD |
| FT | REVISE 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.
