Third Quarter 2024 HCPCS

Date: December 27, 2024

Attention: All Providers

Effective date: October 1, 2024
 

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that Texas Medicaid & Healthcare Partnership (TMHP) implemented the third quarter 2024 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which are effective for dates of service on or after October 1, 2024.

How this impacts providers: The following drug procedure codes have been added as Medicaid benefits effective October 1, 2024:

Third Quarter 2024 HCPCS Added Procedure Codes

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, October 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 October 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

Effective October 1, 2024, the following procedure codes were added as non-covered procedure codes for Texas Medicaid:

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.
 
The following procedure codes were added as benefits for Healthy Texas Women and the state-funded Family Planning Program:

Additional Benefit Information
 
Age limitations apply for the following procedure codes:

Procedure codes L1653 and L1821 require prior authorization. Refer to the current Texas Medicaid Provider Procedures Manual (TMPPM), Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.19.2, “Prior Authorization and Documentation Requirements,” for additional information.

Procedure code Q5135 is restricted to the following diagnosis codes:

Third Quarter 2024 HCPCS Discontinued Procedure Codes
 
Effective October 1, 2024, CMS will discontinue the following procedure codes:

Third Quarter 2024 HCPCS Revised Procedure Codes
 
The description of the following procedure codes will be revised:

Note: Procedure code 0472U will be effective for dates of service on or after July 1, 2024, and procedure codes Q0516, Q0517, and Q0518 will be effective for dates of service on or after September 15, 2024.

Third Quarter 2024 HCPCS Informational Procedure Codes
 
The following procedure codes will be added as informational only:

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.texaschildrenshealthplan.org/provideralerts.