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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 Procedure Codes 

Clinician-Administered Drug (CAD) Procedure Codes   
C9166 C9167 C9168 
J0177 J0577 J0578 
J0650 J0651 J0652 
J1010 J1202 J1203 
J1323 J2277 J2782 
J2919 J3055 J7165 
J7354 J9073 J9075 

Reminder: The CAD 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, 2024. Claims will deny 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, 2024, published rate until the Texas Health and Human Services (HHSC) rate hearing is held as required by the 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 

The following procedure code will be added as a Healthy Texas Women (HTW) benefit: 

CAD Procedure Code 
J7354 

The following procedure codes will be added as HTW Plus benefits: 

CAD Procedure Codes  
J0577 J0578 

Effective April 1, 2024, the following procedure codes will be added as noncovered procedure codes for Texas Medicaid: 

CAD Procedure Codes   
J0209 J0589 J1434 
J2801 J3424 J9074 
J9248 J9249 J9376 
Q5133 Q5134   
Non-CAD Procedure Codes   
A2026 A4271 A4438* 
A4564* A4593 A4594 
A9293 C9796 C9797 
E0152 E0468 E0736* 
E0738 E0739 E2104 
G0138* H0051 K1037 
L1320* L5783 L5841* 
Q4305 Q4306 Q4307 
Q4308 Q4309 Q4310 
S4988 S9002   

Procedure codes noted with an asterisk in the table above will require a Texas Medicaid rate hearing. 

New benefits that are adopted by Texas Medicaid must complete the rate hearing process to receive public comment on proposed Texas Medicaid reimbursement rates. 

After the rate hearing, expenditures must be approved before the rates are adopted by Texas Medicaid. Providers will be notified in a future notification if a proposed reimbursement rate will change, or a procedure code will not be reimbursed because the expenditures are not approved. 

Procedure code E2298 will be a benefit of Texas Medicaid and will not require a rate hearing. 

Additional Benefit Information 

Age limitations will apply for the following procedure codes: 

Procedure Codes Client Age Limitation 
E0736, J1202, J1203, J1323, J3055, J7165 18 years of age or older 

Procedure code A4438 will be limited to clients who are 18 years of age or older with a purchased device and claims history of a neuromuscular electrical stimulation or transcutaneous electrical nerve stimulation procedure within the last five years. 

Procedure code E2298 will require prior authorization and be limited to one purchase per five years. Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.17.15, “Power Seat Elevation System,” for additional information about prior authorization criteria. 

Procedure code G0138 must be billed with procedure code J1203 on the same day by the same provider. Procedure code J1203 must be billed with procedure code J1202 on the same day by the same provider. 

Procedure code J7354 will be restricted to diagnosis code B081 and limited to clients who are 2 years of age or older. 

Procedure code L1320 will require prior authorization and be limited to clients who are birth through 20 years of age.  

Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.19.2, “Prior Authorization and Documentation Requirements,” for additional information about prior authorization criteria. 

Procedure code L5841 will require prior authorization and be limited to clients who are birth through 20 years of age. Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.20.2.1, “Lower-Limb Prostheses,” for additional information about prior authorization criteria. 

Procedure code C9166 will be limited to clients who are 2 years of age or older and restricted to the following diagnosis codes: 

Diagnosis Codes   
L400 L401 L402 
L403 L404 L405 
L4050 L4051 L4052 
L4053 L4054 L4059 
L408 L409 M0880 
M450 M451 M452 
M453 M454 M455 
M456 M457 M458 
M459 M4680 M4681 
M4682 M4683 M4684 
M4685 M4686 M4687 
M4688 M4689   

Procedure code C9168 will be limited to clients who are 18 years of age or older and restricted to the following diagnosis codes: 

Diagnosis Codes   
K5100 K51011 K51012 
K51013 K51014 K51018 
K51019 K5120 K51211 
K51212 K51213 K51214 
K51218 K51219 K5130 
K51311 K51312 K51313 
K51314 K51318 K51319 
K5180 K51811 K51812 
K51813 K51814 K51818 
K51819 K5190 K51911 
K51912 K51913 K51914 
K51918 K51919   

First Quarter 2024 HCPCS Discontinued Procedure Codes 

Effective April 1, 2024, CMS will discontinue the following procedure codes: 

Discontinued Procedure Codes Direct Replacement Procedure Codes 
C9159 J7165 
C9160 J0589 
C9161 J0177 
C9162 J2782 
C9163 J3055 
C9164 J7354 
C9165 J1323 
E2300 E2298 
J0576 J0577, J0578 
J1020 J1010 
J2920 J2919 
J9070 J9075 
Discontinued Procedure Codes with No Direct Replacement   
0354U 0416U J1030 
J1040 J1840 J1850 
J2930 J9250 Q4244 

Discontinued procedure codes will not be reimbursed after March 31, 2024. 

First Quarter 2024 HCPCS Revised Procedure Codes 

The description of the following procedure codes will be revised: 

Procedure Codes   
1066F 2060F 3455F 
A4561 A4562 E2001 
J0208 J0612 J0613 
J3380 J3425 J7516 
J9029 J9255 J9260 

Note: Procedure codes 1066F, 2060F, and 3455F will be effective for dates of service on or after January 1, 2024. 

First Quarter 2024 HCPCS Informational Procedure Codes 

The following procedure codes will be added as informational only: 

Procedure Codes   
0439U 0440U 0441U 
0442U 0443U 0444U 
0445U 0446U 0447U 
0448U 0449U   

Next step for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.