hcpcs special bulletin - tmhpjanuary 2015 no. 7. 2015 healthcare common procedure coding system...

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JANUARY 2015 NO. 7 2015 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin HCPCS Special Bulletin HCPCS Special Bulletin Copyright Acknowledgments Use of the American Medical Association’s (AMA) copyrighted CPT® is allowed in this publication with the following disclosure: “Current Procedural Terminology (CPT) is copyright 2013 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. e AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regula- tion System/ Defense Federal Acquisition Regulation Supplement (FARS/DFARS) apply.” e American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT) codes: “Current Dental Terminology (including procedure codes, nomenclature, descriptors, and other data contained therein) is copyright © 2012 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.” 2015 HCPCS Implementation On January 1, 2015, the Texas Medicaid & Healthcare Partnership (TMHP) applied the 2015 annual Healthcare Common Procedure Coding System (HCPCS) updates that are effective for dates of service on or after January 1, 2015. is combined Special Bulletin includes the HCPCS updates for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. is bulletin is intended to notify providers of program and coding changes related to the 2015 updates for HCPCS and Current Procedural Terminology (CPT®). All providers are encouraged to review the General Information Section of this bulletin. Policy updates for a specific program or provider type are discussed in the designated sections of the bulletin. Rate Hearings and Expenditure Review New and increased benefits that are adopted by Texas Medicaid must complete the rate hearing process in order to receive comments on new and increased Texas Medicaid reimbursement rates. e CSHCN Services Program reviews the adopted Texas Medicaid rates to determine whether the rates are fiscally feasible for the CSHCN Services Program. All new, revised, and discontinued 2015 HCPCS procedure codes are effective for dates of service on or after January 1, 2015. The new procedure codes that are designated with asterisks (*) in the Texas Medicaid Allowable and the CSHCN Services Program Allowable columns of the table located on page 19 of this bulletin must complete the rate hearing process, and expenditures must be approved before the rates are adopted by Texas Medicaid and the CSHCN Services Program. Providers will be notified in a future banner message or web article if a new procedure code will not be reimbursed because the expenditures were not approved. Providers may refer to the following resources for more information about the public rate hearings and approval of expenditures: Title 2 Human Resources Code, §32.0282, and Title 1 Texas Administrative Code (TAC), §355.201, which require public hearings House Bill 1, 80th Legislature, Regular Session, 2007, Article II, Department of State Health Services, Rider 79a

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Page 1: HCPCS Special Bulletin - TMHPJANUARY 2015 NO. 7. 2015 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin HCPCS Special Bulletin

JANUARY 2015 NO. 7

2015 Healthcare Common Procedure Coding System (HCPCS) Special BulletinHCPCS Special BulletinHCPCS Special Bulletin

Copyright AcknowledgmentsUse of the American Medical Association’s (AMA) copyrighted CPT® is allowed in this publication with the following disclosure:

“Current Procedural Terminology (CPT) is copyright 2013 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regula­tion System/ Defense Federal Acquisition Regulation Supplement (FARS/DFARS) apply.”

The American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT) codes:

“Current Dental Terminology (including procedure codes, nomenclature, descriptors, and other data contained therein) is copyright © 2012 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.”

2015 HCPCS ImplementationOn January 1, 2015, the Texas Medicaid & Healthcare Partnership (TMHP) applied the 2015 annual Healthcare Common Procedure Coding System (HCPCS) updates that are effective for dates of service on or after January 1, 2015.

This combined Special Bulletin includes the HCPCS updates for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. This bulletin is intended to notify providers of program and coding changes related to the 2015 updates for HCPCS and Current Procedural Terminology (CPT®).

All providers are encouraged to review the General Information Section of this bulletin. Policy updates for a specific program or provider type are discussed in the designated sections of the bulletin.

Rate Hearings and Expenditure ReviewNew and increased benefits that are adopted by Texas Medicaid must complete the rate hearing process in order to receive comments on new and increased Texas Medicaid reimbursement rates. The CSHCN Services Program reviews the adopted Texas Medicaid rates to determine whether the rates are fiscally feasible for the CSHCN Services Program.

All new, revised, and discontinued 2015 HCPCS procedure codes are effective for dates of service on or after January 1, 2015. The new procedure codes that are designated with asterisks (*) in the Texas Medicaid Allowable and the CSHCN Services Program Allowable columns of the table located on page 19 of this bulletin must complete the rate hearing process, and expenditures must be approved before the rates are adopted by Texas Medicaid and the CSHCN Services Program. Providers will be notified in a future banner message or web article if a new procedure code will not be reimbursed because the expenditures were not approved.

Providers may refer to the following resources for more information about the public rate hearings and approval of expenditures:

• Title 2 Human Resources Code, §32.0282, and Title 1 Texas Administrative Code (TAC), §355.201, which requirepublic hearings

• House Bill 1, 80th Legislature, Regular Session, 2007, Article II, Department of State Health Services, Rider 79a

Page 2: HCPCS Special Bulletin - TMHPJANUARY 2015 NO. 7. 2015 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin HCPCS Special Bulletin

INSIDE

General Information 12015 HCPCS Implementation ..............................................................................................1Rate Hearings and Expenditure Review ..............................................................................1Claims Filing ........................................................................................................................3Code Updates Web Page ....................................................................................................3

Medicaid Fee-for-Service and Managed Care Providers 3Texas Medicaid HCPCS Updates ........................................................................................3

Home Health and Comprehensive Care Program (CCP) Providers 11Home Health Services Benefit Changes ........................................................................... 11ASC/HASC Code Additions ............................................................................................... 11CCP Services Benefit Changes .........................................................................................12

THSteps Providers 13THSteps Dental Benefit Changes ......................................................................................13

DSHS EPHC Providers 13DSHS EPHC Services Benefit Changes ...........................................................................13

DSHS Family Planning Providers 13DSHS Family Planning Services Benefit Changes ............................................................13

Texas Women’s Health Program (TWHP) Providers 13TWHP Providers Benefit Changes .....................................................................................13

Children With Special Health Care Needs (CSHCN) Services Program Providers 14CSHCN Services Program Updates ..................................................................................14CSHCN Services Program Benefit Changes .....................................................................14

All Code Changes: Added, Revised, Replacement, and Discontinued 192015 HCPCS Procedure Code Additions...........................................................................19Discontinued Procedure Codes ......................................................................................... 37Replacement Procedure Codes .........................................................................................38Procedure Code Description Changes ..............................................................................38Modifiers ............................................................................................................................39

Prior Authorization Changes 39Authorization or Prior Authorization ...................................................................................39

Texas Medicaid Special Bulletin, No. 7 2 2015 HCPCS Special BulletinCPT only copyright 2014 American Medical Association. All rights reserved.

Page 3: HCPCS Special Bulletin - TMHPJANUARY 2015 NO. 7. 2015 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin HCPCS Special Bulletin

Claims FilingThe new 2015 HCPCS procedure codes may be billed beginning January 1, 2015, and must be submitted within the initial 95­day filing deadline. Services provided before the rate hearing is completed and expendi­tures are approved will be denied with an explanation of benefits (EOB) 02008, “This procedure code has been approved as a benefit pending the approval of expenditures. Providers will be notified of the effective dates of service in a future notification if expenditures are approved.”

Note: In the rare instance that expenditures are not approved for a particular procedure code, that procedure code will not be made a benefit effective January 1, 2015.

Once expenditures are approved, TMHP will automatically reprocess the affected claims. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete. When the affected claims are reprocessed, providers may receive additional payment, which will be reflected on Remittance and Status (R&S) Reports.

If the effective date of service changes for one or more of the new procedure codes, providers will be notified in a future article. The client cannot be billed for these services.

Important: To avoid fraudulent billing, providers must submit the procedure codes that are most appropriate for the services provided.

Code Updates Web PageProviders are encouraged to refer to the TMHP Code Updates – HCPCS web page at www.tmhp.com/Pages/CodeUpdates/HCPCS_2015.aspx for reimbursement rates, quarterly HCPCS updates, and all other notifica­tions about HCPCS procedure codes.

MEDICAID FEE-FOR-SERVICE AND MANAGED CARE PROVIDERS

Texas Medicaid HCPCS UpdatesThe 2015 Healthcare Common Procedure Coding System (HCPCS) updates including prior authorization updates for Texas Medicaid are included in the HCPCS tables in the All Code Changes Section of this bulletin beginning on page 19. The 2015 HCPCS deletions and replacements are effective January 1, 2015, for dates of service on or after January 1, 2015, for Texas Medicaid. Providers may refer to the General Information Section for more information.

Authorization and Prior Authorization Update ReminderEffective January 1, 2015, the 2015 HCPCS deleted procedure codes are no longer reimbursed by Texas Medicaid. Unless otherwise indicated on page 39 of this bulletin, providers who have received prior authorization for dates of service that occur on, after, or encompass January 1, 2015, must submit a written request on the appropriate, completed Texas Medicaid prior authorization request form in order to update the HCPCS procedure codes authorized for those services.

Providers may refer to the section of this bulletin titled Prior Authorization Changes for information about obtaining authorization or prior authorization.

Texas Medicaid Special Bulletin, No. 7 3 2015 HCPCS Special Bulletin

Medicaid Fee­for­Service and Managed Care Providers

CPT only copyright 2014 American Medical Association. All rights reserved.

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Texas Medicaid Benefit ChangesThe following Texas Medicaid benefit changes have been made to support the 2015 HCPCS and Current Proce­dural Terminology (CPT) updates and are effective for dates of service on or after January 1, 2015. For more infor­mation, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 1­800­925­9126.

Note: These changes apply to Texas Medicaid fee-for-service and Medicaid managed care claims and authorization requests that are submitted to TMHP for processing.

The policy articles in this bulletin contain the following information:

• Revised: The description has been revised for these procedure codes. Providers may refer to the appropriate copyright holder for the revised descriptions.

• Discontinued: Discontinued procedure codes are no longer reimbursed after December 31, 2014.

• Added: Added procedure codes are new procedure codes added by the Centers for Medicare & Medicaid Services (CMS). Procedure codes noted with an asterisk (*) require a rate hearing for pricing.

• Limitations: Additional benefit and limitation information for the added procedure codes.

• Replacement: Replacement procedure codes directly replace the indicated discontinued procedure code. The discontinued procedure codes are no longer reimbursed after December 31, 2014, and the replacement procedure codes are effective for dates of service on or after January 1, 2015. Not all discontinued procedure codes have direct replacements.

Anesthesia ReimbursementDiscontinued Procedure Codes00452 00622

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.6, “Anesthesia,” for additional information.

Blood Factor ProductsAdded Procedure CodesC9136 J7181 J7200 J7201Discontinued Procedure CodeC9133

Limitations for added procedure codes: Procedure codes C9136, J7181, J7200, and J7201 may be reimbursed as follows:

• To physician assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS), and physician providers for services rendered in the office setting

• To hospital providers for services rendered in the outpatient hospital setting

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.39.8, “Blood Factor Products,” for additional information.

Texas Medicaid Special Bulletin, No. 7 4 2015 HCPCS Special Bulletin

Medicaid Fee­for­Service and Managed Care Providers

CPT only copyright 2014 American Medical Association. All rights reserved.

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BrachytherapyAdded Procedure Codes77316 77317 77318

Limitations for added procedure codes: Procedure codes 77316, 77317, and 77318 may be reimbursed as follows:

• The total component may be reimbursed to physician providers and radiation treatment center providers for services rendered in the office setting. Services rendered in the outpatient hospital setting may be reimbursed to radiation treatment center and hospital providers.

• The professional component may be reimbursed to physician and radiation treatment center providers for services rendered in the office and outpatient hospital settings. Services rendered in the inpatient hospital setting may be reimbursed to physician providers.

• The technical component may be reimbursed to physician and radiation treatment center providers for services rendered in the office setting. Services rendered in the outpatient hospital setting may be reimbursed to radiation treatment center providers.

Diagnostic EndoscopiesAdded Procedure Codes44406 44407 G6021 G6027 G6028Discontinued Procedure Codes45355 C9735

Limitations for added procedure codes: Procedure code G6021, G6027, and G6028 may be reimbursed to physician providers in the office, inpatient, and outpatient hospital settings.

Procedure codes 44406 and 44407 may be reimbursed as follows:

• To physician providers in the office, inpatient, and outpatient hospital settings

• To ambulatory surgical center (ASC) providers in the outpatient hospital setting

Doctor of Dentistry Services as a Limited PhysicianDiscontinued Procedure Code42508

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physi-cians, and Physician Assistants Handbook, Section 9.3, “Doctor of Dentistry Practicing as a Limited Physician,” and the Children’s Services Handbook, subsection 4.1.4, “Doctor of Dentistry Practicing as a Limited Physician,” for additional information.

Evoked Response Tests and Neuromuscular ProceduresWhen the same studies are performed on unique sites by the same provider for the same date of service, studies for the first site must be billed without a modifier and studies for each additional site must be billed with a modifier, that indicates a distinct procedural service.

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Use the following most descriptive HCPCS modifier when appropriate: XE, XP, XS, or XU. Modifier 59 should be used only when modifier XE, XP, XS, or XU is not appropriate.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians and Physician Assistants Handbook, subsection 9.2.28, “Evoked Response Tests and Neuromuscular Procedures,” for additional information.

Extracorporeal Membrane Oxygenation (ECMO)Added Procedure Codes33946 33947 33948 33949 33951 33952 33953 33954 33955 3395633957 33958 33959 33962 33963 33964 33965 33966 33969 3398433985 33986 33987 33988 33989Discontinued Procedure Codes33960 33961 36822

Limitations for added procedure codes: The above procedure codes may be reimbursed to physician providers in the inpatient hospital setting.

Procedure codes 33946, 33947, 33948, and 33949 are limited to one per day, any provider.

Procedure code 33946 will be denied as part of procedure code 33948 if billed by any provider on the same date of service. Procedure code 33947 will be denied as part of procedure code 33949 if billed by any provider on the same date of service.

Procedure codes 33951, 33952, 33953, 33954, 33955, and 33956 will not be reimbursed when submitted with the same date of service as procedure code 33946, 33947, 33948, or 33949.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.29, “Extracorporeal Membrane Oxygenation (ECMO),” for additional information.

Genetic Testing for Colorectal CancerAdded Procedure Code81288

Limitations for added procedure code: Procedure code 81288 may be reimbursed to independent laboratory providers in the laboratory setting.

Procedure code 81288 is limited to one service per lifetime, any provider.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.15.3, “Genetic Testing for Colorectal Cancer,” for additional information.

Texas Medicaid Special Bulletin, No. 7 6 2015 HCPCS Special Bulletin

Medicaid Fee­for­Service and Managed Care Providers

CPT only copyright 2014 American Medical Association. All rights reserved.

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Hyperbaric Oxygen TherapyAdded Procedure CodeG0277Discontinued Procedure CodeC1300

Limitations for added procedure code: Procedure code G0277 may be reimbursed to hospital providers for services rendered in the outpatient hospital setting.

Procedure code G0277 will require prior authorization before the date the service is initiated, and must be billed with revenue code B­413 on the same claim. If procedure code G0277 is not on the same claim as revenue code B­413, the claim will be denied.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Inpatient and Outpatient Hospital Services Handbook, subsection 4.2.13, “Hyperbaric Oxygen Therapy (HBOT),” and the Medical and Nursing Special-ists, Physicians, and Physician Assistants Handbook, subsection 9.2.33, “Hyperbaric Oxygen Therapy (HBOT),” for additional information.

Intravenous (IV) Therapy and SuppliesAdded Procedure CodeA4602

Limitations for added procedure code: Procedure code A4602 may be reimbursed to home health DME and medical supplier (DME) providers in the home setting.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.11.5, “External Insulin Pump and Supplies,” subsection 2.2.14, “Intravenous (IV) Therapy Equipment and Supplies,” and subsection 2.2.14.1, “Prior Authorization,” for additional information.

Iron InjectionsAdded Procedure CodeJ1439

Limitations for added procedure code: Procedure code J1439 may be reimbursed as follows:

• To PA, NP, CNS, and physician providers for services rendered in the office setting

• To hospital providers for services rendered in the outpatient hospital setting

Ferric carboxymaltose (J1439) may be indicated for, but is not limited to, treatment of iron deficiency anemia for adult clients with:

• Intolerance or unsatisfactory response to oral iron

• Non­dialysis­dependent chronic kidney disease

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physicians Assistants Handbook, subsection 9.2.39, “Medications ­ Injectable,” for additional information.

Texas Medicaid Special Bulletin, No. 7 7 2015 HCPCS Special Bulletin

Medicaid Fee­for­Service and Managed Care Providers

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Joint Injections and Trigger Point InjectionsAdded Procedure Codes20604 20606 20611

Limitations for added procedure codes: Procedure codes 20604, 20606, and 20611 may be reimbursed as follows:

• To PA, NP, CNS, physician, dentists practicing as a limited physician, and podiatrist providers for services rendered in the office, inpatient, and outpatient hospital settings

• To ASC providers for services rendered in the outpatient hospital setting

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physi-cians, and Physician Assistants Handbook, subsection 9.2.39.19, “Joint Injections and Trigger Point Injections,” for additional information.

Neurostimulators and Neuromuscular StimulatorsAdded Procedure CodeL8696Discontinued Procedure Code61875

Limitations for added procedure code: Procedure code L8696 may be reimbursed as follows:

• To physician providers for services rendered in the office setting

• To home health DME and medical supplier (DME) providers for services rendered in the home setting

• To hospital providers for services rendered in the outpatient hospital setting

Procedure code L8696 may be reimbursed for clients with a purchased device and a claims history of a prior neuro­stimulator or neuromuscular stimulator implantation within the last 5 years.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.44, “Neurostimulators,” for additional information.

Outpatient Behavioral Health ServicesDiscontinued Procedure CodeM0064

Note: Pharmacological management and oversight must be billed using the most appropriate evaluation and manage-ment (E/M) procedure code as part of the E/M visit.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook, Section 6.4, “Outpatient Behavioral Health Services,” and Section 6.8, “Pharmaco­logical Regimen Oversight,” for additional information.

Texas Medicaid Special Bulletin, No. 7 8 2015 HCPCS Special Bulletin

Medicaid Fee­for­Service and Managed Care Providers

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Prognostic Breast and Gynecological Cancer StudiesAdded Procedure Codes81519 88341 88344 88364 88366 88369 88373 88374 88377

Limitations for added procedure codes: Procedure codes 88341, 88344, 88364, 88366, 88369, 88373, 88374, and 88377 may be reimbursed as follows:

• To physician providers for services rendered in the office setting

• To hospital providers for services rendered in the outpatient hospital setting

• To laboratory providers for services rendered in the independent laboratory setting

Procedure code 88341 is an add­on code and must be billed along with primary procedure code 88342.

Procedure code 88364 is an add­on code and must be billed along with primary procedure code 88365.

Procedure code 88369 is an add­on code and must be billed along with primary procedure code 88368.

Procedure code 88373 is an add­on code and must be billed along with primary procedure code 88367.

Procedure code 81519 may be reimbursed for female clients as follows:

• To physician providers for services rendered in the office setting

• To hospital providers for services rendered in the outpatient hospital setting

• To physician and laboratory providers for services rendered in the independent laboratory setting

Procedure code 81519 is limited to the following diagnosis codes: Diagnosis Codes1740 1741 1742 1743 1744 1745 1746 1748 1749 2330V860

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.15.5, “Prognostic Breast and Gynecological Cancer Studies,” for additional information.

Screening and Diagnostic Studies of the BreastAdded Procedure Codes76641 76642Discontinued Procedure Code76645

Limitations for added procedure codes: Procedure codes 76641 and 76642 may be reimbursed as follows:

• The total component rendered in the office setting may be reimbursed to PA, NP, CNS, and physician providers; services rendered in the outpatient hospital setting may be reimbursed to hospital providers.

• The professional component may be reimbursed to PA, NP, CNS, and physician providers in the office setting; services rendered in the inpatient hospital and outpatient hospital settings may be reimbursed to physician providers.

Texas Medicaid Special Bulletin, No. 7 9 2015 HCPCS Special Bulletin

Medicaid Fee­for­Service and Managed Care Providers

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• The technical component may be reimbursed to PA, NP, CNS, physician, portable x­ray supplier, radiological lab, and physiological lab providers for services rendered in the office setting.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.15.4, “Mammography (Screening and Diagnostic Studies of the Breast),” for additional information.

Stereotactic RadiosurgeryAdded Procedure CodeG6002Discontinued Procedure Code77421 G0251

Limitations for added procedure code: Procedure code G6002 may be reimbursed as follows:

• To physician and radiation treatment center providers for services rendered in the office setting.

• To radiation treatment centers and hospital providers for services rendered in the outpatient hospital setting.

• To physician providers for professional component services rendered in the office, inpatient, and outpatient hospital settings.

• To physician and radiation treatment center providers for technical component services rendered in the office setting.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.63.2.1, “Prior Authorization for Stereotactic Radiosurgery,” and the Inpatient and Outpatient Hospital Services Handbook, subsection 4.2.9, “Computated Tomography and Magnetic Resonance Imaging,” for additional information.

Telemedicine and Telehealth ServicesAdded Procedure CodeM0064

Note: Pharmacological management and oversight must be billed using the most appropriate evaluation and manage-ment (E/M) procedure code as part of the E/M visit.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook, subsection 3.1.1, “Distant Site,” for additional information.

Vaccines and ToxoidsAdded Procedure Code90630

Limitations for added procedure code: Procedure code 90630 may be reimbursed for clients who are 21 years of age and older as follows:

• To PA, NP, CNS, certified nurse midwife (CNM), physician, comprehensive care program (CCP), pharma­cist, federally qualified health center (FQHC), and Texas Health Steps (THSteps) medical providers for services rendered in the office setting

• To PA, NP, CNS, physician, CCP, FQHC, and THSteps medical providers for services rendered in the home setting

Texas Medicaid Special Bulletin, No. 7 10 2015 HCPCS Special Bulletin

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• To hospital, FQHC, and THSteps medical providers for services rendered in the outpatient hospital setting

• To FQHC and THSteps medical providers for services rendered in the other location setting

Procedure code 90630 must be billed with a vaccine administration procedure code to identify the vaccine administered.

Note: Procedure code 90630 is informational only for clients who are 6 months through 20 years of age and may be obtained through the Texas Vaccines for Children Program. Procedure code 90630 must be billed with a vaccine admin-istration procedure code to identify the vaccine administered.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, subsection 5.3.11.3, “Immunizations,” and subsection B.3.2.2, “Immunizations (Vaccine/Toxoids),” and the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.35.1, “Administration Fee,” subsec­tion 9.2.36.2, “Vaccine and Toxoid Procedure Codes,” and subsection 9.2.37, “Immunizations for Clients Who Are 21 Years of Age and Older,” for additional information.

HOME HEALTH AND COMPREHENSIVE CARE PROGRAM (CCP) PROVIDERS

Home Health Services Benefit ChangesThe following Texas Medicaid Home Health Services benefit changes have been made to support the 2015 Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) updates and are effective for dates of service on or after January 1, 2015. For more information, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 1­800­925­9126.

Diabetic Equipment and Supplies – Home HealthAdded Procedure CodeA4602

Limitations for added procedure code: Procedure code A4602 may be reimbursed to home health durable medical equipment (DME) and medical supplier (DME) providers in the home setting.

Procedure code A4602 is limited to 1 per 6 months.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.11, “Diabetic Equipment and Supplies,” for additional information.

ASC/HASC Code AdditionsAdditions for ambulatory surgical center/hospital ambulatory surgical center (ASC/HASC) facilities are listed with appropriate group payments in the 2015 Healthcare Common Procedure Coding System (HCPCS) procedure code additions table located on page 19 and replacement procedure codes table located on page 38 of this bulletin.

For more information, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 1­800­925­9126.

Texas Medicaid Special Bulletin, No. 7 11 2015 HCPCS Special Bulletin

Home Health and Comprehensive Care Program (CCP) Providers

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CCP Services Benefit ChangesThe following Texas Medicaid CCP benefit changes have been made to support the 2015 HCPCS and CPT updates and are effective for dates of service on or after January 1, 2015. For more information, call the TMHP Contact Center at 1­800­925­9126.

Orthoses CCPAdded Procedure CodeL3981

Limitations for added procedure code: Procedure code L3981 requires prior authorization and may be reimbursed for clients who are birth through 20 years of age as follows:

• To orthotist and medical supplier (DME) providers in the home setting

• To hospital providers in the outpatient hospital setting

Prosthesis CCPAdded Procedure CodesL6026 L7259Discontinued Procedure CodesL6025 L7260 L7261

Limitations for added procedure code: Procedure codes L6026 and L7259 require prior authorization and may be reimbursed for clients who are birth through 20 years of age to prosthetist and medical supplier (DME) providers in the home setting.

Screening Brief Intervention and Referral to Treatment (SBIRT) CCPDiscontinued Procedure CodeM0064

Note: Pharmacological management and oversight must be billed using the most appropriate evaluation and manage-ment (E/M) procedure code as part of the E/M visit.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook, Section 7.5, “Reimbursement and Limitations,” for additional information.

Texas Medicaid Special Bulletin, No. 7 12 2015 HCPCS Special Bulletin

Home Health and Comprehensive Care Program (CCP) Providers

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THSTEPS PROVIDERS

THSteps Dental Benefit ChangesThe following Texas Health Steps (THSteps) dental services benefit changes have been made to support the 2015 Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) updates and are effective for dates of service on or after January 1, 2015. For more information, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 1­800­925­9126.

Texas Health Steps (THSteps) Therapeutic Dental ServicesAdded Procedure CodeD6549Discontinued Procedure CodeD6975

Limitations for added procedure code: Procedure code D6549 may be reimbursed to FQHC, THSteps dental, orthodontist, and oral maxillofacial surgeon providers for services rendered in the office, inpatient hospital, and outpatient hospital settings.

Procedure code D6549 will require prior authorization and will be limited to clients who are 16 through 20 years of age.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, subsection 4.2.21, “Prosthodontic (Fixed) Services,” for additional information.

DSHS EPHC PROVIDERS

DSHS EPHC Services Benefit ChangesThe 2015 HCPCS updates included added procedure codes for the Department of State Health Services (DSHS) Expanded Primary Health Care (EPHC) program. Updates for the EPHC program are included in the HCPCS tables in the All Code Changes Section of this bulletin beginning on page 19.

DSHS FAMILY PLANNING PROVIDERS

DSHS Family Planning Services Benefit ChangesThe 2015 HCPCS updates include added procedure codes for the DSHS Family Planning (FP) program. Updates for the FP program are included in the HCPCS tables in the All Code Changes Section of this bulletin beginning on page 19.

TEXAS WOMEN’S HEALTH PROGRAM (TWHP) PROVIDERS

TWHP Providers Benefit Changes

No benefit changes have been made to the Texas Women’s Health Program (TWHP) in response to the 2015 Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) updates.

Texas Medicaid Special Bulletin, No. 7 13 2015 HCPCS Special Bulletin

THSteps Providers

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CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN) SERVICES PROGRAM PROVIDERS

CSHCN Services Program UpdatesThe 2015 HCPCS updates including authorization and prior authorization updates for the CSHCN Services Program are included in the Healthcare Common Procedure Coding System (HCPCS) tables in the All Code Changes Section of this bulletin beginning on page 19. The 2015 HCPCS deletions and replacements are effective January 1, 2015, for dates of service on or after January 1, 2015, for the CSHCN Services Program. Providers may refer to the General Information Section for more information.

Authorization and Prior Authorization Update ReminderEffective January 1, 2015, the 2015 HCPCS deleted procedure codes are no longer reimbursed by the CSHCN Services Program. Unless otherwise indicated on page 39 of this bulletin, providers who have received authorizations or prior authorizations for dates of service that occur on, after, or encompass January 1, 2015, must submit a written request on the appropriate, completed CSHCN Services Program authorization or prior authoriza­ tion request form in order to update the HCPCS procedure codes authorized for those services.

Providers may refer to the section of this bulletin titled, Prior Authorization Changes, for information about obtaining authorization or prior authorization.

For more information, call the Texas Medicaid & Healthcare Partnership (TMHP)­CSHCN Services Program Contact Center 1­800­568­2413.

CSHCN Services Program Benefit ChangesThe following CSHCN Services Program benefit changes have been made to support the 2015 HCPCS and Current Procedural Terminology (CPT) updates and are effective for dates of service on or after January 1, 2015. For more information, call the TMHP­CSHCN Services Program Contact Center at 1­800­925­9126.

The policy articles below contain the following information:

• Revised: The description has been revised for these procedure codes. Providers may refer to the appropriatecopyright holder for the revised descriptions.

• Discontinued: Discontinued procedure codes are no longer reimbursed after December 31, 2014.

• Added: Added procedure codes are new procedure codes added by the Centers for Medicare & Medicaid Services(CMS). Procedure codes noted with an asterisk (*) require a rate hearing for pricing.

• Limitations: Additional benefit and limitation information for the added procedure codes.

• Replacement: Replacement procedure codes directly replace the indicated discontinued procedure code. Thediscontinued procedure codes are no longer reimbursed after December 31, 2014, and the replacement procedurecodes are effective for dates of service on or after January 1, 2015. Not all discontinued procedure codes havedirect replacements.

Note: For the purposes of this section for CSHCN Services Program benefit changes, “advanced practice registered nurse (APRN)” includes nurse practitioner (NP) and clinical nurse specialist (CNS) providers only.

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Children With Special Health Care Needs (CSHCN) Services Program Providers

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Anesthesia ServicesDiscontinued Procedure Codes00452 00622

Providers may refer to the CSHCN Services Program Provider Manual, subsection 31.2.4, “Anesthesia Services,” for additional information.

Behavioral HealthDiscontinued Procedure CodeM0064

Note: Pharmacological management and oversight must be billed using the most appropriate evaluation and manage-ment (E/M) procedure code as part of the E/M visit.

Providers may refer to the CSHCN Services Program Provider Manual, subsection 29.2.4, “Pharmacological Regimen Oversight Documentation,” and subsection 29.2.9, “Pharmacological Regimen Oversight and Pharmaco­logical Management,” for additional information.

Cleft-Craniofacial ServicesDiscontinued Procedure Codes62116

Providers may refer to the CSHCN Services Program Provider Manual, subsection 14.2.7.3, “Cleft/Craniofacial Surgery by a Dentist Physician,” and subsection 31.2.36.11, “Cleft/Craniofacial Procedures,” for additional information.

Dental – Therapeutic ServicesAdded Procedure CodeD6549Discontinued Procedure CodesD6053 D6054 D6078 D6079 D6975

Limitations for added procedure code: Procedure code D6549 may be reimbursed for clients who are 16 through 20 years of age to dental and FQHC providers for services rendered in the office, inpatient, and outpatient hospital settings.

Providers may refer to the CSHCN Services Program Provider Manual, subsection 14.2.2.5, “Radiographs or Diagnostic Imaging,” for additional information.

Diabetic Equipment and SuppliesAdded Procedure CodeA4602

Limitations for added procedure code: Procedure code A4602 may be reimbursed to home health DME, medical supplier (DME), and custom DME providers in the home setting.

Procedure code A4602 is limited to 1 per 6 months.

Providers may refer to the CSHCN Services Program Provider Manual, subsection 15.2.2, “Insulin Pump,” for additional information.

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Children With Special Health Care Needs (CSHCN) Services Program Providers

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Doctor of Dentistry Services as a Limited PhysicianDiscontinued Procedure Code42508

Providers may refer to the CSHCN Services Program Provider Manual, subsection 14.2.7, “Doctor of Dentistry Services as a Limited Physician,” for additional information.

Evoked Response Tests and Neuromuscular ProceduresWhen the same studies are performed on unique sites by the same provider for the same date of service, studies for the first site must be billed without a modifier and studies for each additional site must be billed with a modifier that indicates a distinct procedural service.

Use the following most descriptive HCPCS modifier when appropriate: XE, XS, XP, or XU. Modifier 59 should be used only when modifier XE, XP, XS, or XU is not appropriate.

Providers may refer to the CSHCN Services Program Provider Manual, Section 31, “Evoked Response Tests and Neuromuscular Procedures,” for additional information.

Genetic Testing for Colorectal CancerAdded Procedure Code81288

Limitations for added procedure code: Procedure code 81288 may be reimbursed to independent laboratory providers in the laboratory setting.

Procedure code 81288 is limited to one service per lifetime, any provider.

Providers may refer to the CSHCN Services Program Provider Manual, subsection 25.2.5.2, “Genetic Testing for Colorectal Cancer,” for additional information.

Hyperbaric Oxygen TherapyAdded Procedure CodeG0277Discontinued Procedure CodeC1300

Limitations for added procedure code: Procedure code G0277 may be reimbursed to hospital providers for services rendered in the outpatient hospital setting.

Prior authorization is required for procedure code G0277.

Providers may refer to the CSHCN Services Program Provider Manual, subsection 24.4.1.6, “Hyperbaric Oxygen Therapy,” subsection 31.2.22, “Hyperbaric Oxygen Therapy (HBOT),” and subsection 31.2.22.1, “Prior Authoriza­tion Requirements,” for additional information.

Texas Medicaid Special Bulletin, No. 7 16 2015 HCPCS Special Bulletin

Children With Special Health Care Needs (CSHCN) Services Program Providers

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Medications Blood Factor ProductsAdded Procedure CodesC9136 J7181 J7200 J7201Discontinued Procedure CodeC9133 C9134

Limitations for added procedure codes: Procedure codes C9136 and J7201 may be reimbursed as follows:

• To PA, APRN, and physician providers for services rendered in the office setting

• To medical supplier (DME) and hemophilia factor providers in the home setting

• To hospital providers in the outpatient hospital setting

Procedure codes C9136 and J7201 are restricted to diagnosis codes 2860 and 2863.

Procedure codes J7181 and J7200 may be reimbursed as follows:

• To PA, APRN, and physician providers for services rendered in the office setting

• To medical supplier (DME) and hemophilia factor providers in the home setting

• To hospital providers in the outpatient hospital setting

Procedure codes J7181 and J7200 are restricted to diagnosis code 2863.

Providers may refer to the CSHCN Services Program Provider Manual, subsection 24.4.1.1 “Blood Factor Products,” and subsection 31.2.8 “Blood Factor Products,” for additional information.

Neurostimulators and Neuromuscular StimulatorsAdded Procedure CodeL8696Discontinued Procedure Codes61875

Limitations for added procedure code: Procedure code L8696 may be reimbursed as follows:

• To home health DME, medical supplier (DME), and custom DME providers for services rendered in the home setting

• To hospital providers for services rendered in the outpatient hospital setting

Procedure code L8696 may be reimbursed for clients with a purchased device and a claims history of a prior neuro­stimulator or neuromuscular stimulator implantation within the last 5 years.

Providers may refer to the CSHCN Services Program Provider Manual, Section 27, “Neurostimulators and Neuro­muscular Stimulators,” for additional information.

Orthoses and ProsthesesAdded Procedure CodesL3981 L6026 L7259

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Children With Special Health Care Needs (CSHCN) Services Program Providers

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Discontinued Procedure CodesL6025 L7260 L7261

Limitations for added procedure codes: Procedure codes L3981, L6026, and L7259 require prior authorization and may be reimbursed to home health DME, orthotist, prosthetist, and medical supplier (DME) providers in the home setting.

Providers may refer to the CSHCN Services Program Provider Manual, subsection 28.4.2, “Prostheses Procedure Codes,” for additional information.

Radiation Therapy ServicesAdded Procedure Codes77306 77307 77316 77317 77318 77385 77386 77387 G6002 G6003G6004 G6005 G6006 G6007 G6008 G6009 G6010 G6011 G6012 G6013G6014 G6015 G6016 G6017Discontinued Procedure Codes77305 77310 77315 77326 77327 77328 77403 77404 77406 7740877409 77411 77413 77414 77416 77418 77421 G0251

Limitations for added procedure codes: The added procedure codes listed in the table above for the total radiation therapy component may be reimbursed to physician and radiation treatment center providers for services rendered in the office setting and to radiation treatment center and hospital providers in the outpatient hospital setting.

Procedure codes 77306, 77307, 77316, 77317, 77318, and 77387 may be reimbursed for the professional component to physician providers in the office, inpatient hospital, and outpatient hospital settings.

Procedure codes 77306, 77307, 77316, 77317, 77318, and 77387 may be reimbursed for the technical component to physician and radiation treatment center providers for services rendered in the office setting and to radiation treatment center providers in the outpatient hospital setting.

Providers may refer to the CSHCN Services Program Provider Manual, subsection 33.2.3, “Intensity Modulated Radiation Therapy (IMRT),” subsection 33.2.8, “Stereotactic Radiosurgery,” subsection 33.2.4, “Medical Radiation Physics, Dosimetry, Treatment Devices, and Special Services,” and subsection 33.2.7, “Radiation Treatment Management and Delivery,” for additional information.

Telemedicine and Telehealth ServicesDiscontinued Procedure CodeM0064

Note: Pharmacological management and oversight must be billed using the most appropriate evaluation and manage-ment (E/M) procedure code as part of the E/M visit.

Providers may refer to the CSHCN Services Program Provider Manual, subsection 37.2.1.1, “Distant Site,” for additional information.

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Children With Special Health Care Needs (CSHCN) Services Program Providers

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Vaccines and ToxoidsAdded Procedure Code90630

Limitations for added procedure code: Procedure code 90630 may be reimbursed for clients who are six months of age and older as follows:

• To PA, APRN, physician, and pharmacist providers for services rendered in the office setting

• To PA, APRN, and physician providers for services rendered in the home and other location settings

• To hospital providers for services rendered in the outpatient hospital setting

Providers may refer to the CSHCN Services Program Provider Manual, subsection 31.2.23.9, “Vaccine and Toxoid Procedure Codes,” for additional information.

ALL CODE CHANGES: ADDED, REVISED, REPLACEMENT, AND DISCONTINUED

2015 HCPCS Procedure Code AdditionsThe following is a list of new Healthcare Common Procedure Coding System (HCPCS) procedure codes that do not replace existing codes:

TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

2 20604 * * None MDF 20604 * * None MD2 20606 * * None MDF 20606 * * None MD2 20611 * * None MDF 20611 * * None MD2 20983 NC NC NoneF 20983 NC NC None2 21811 NC NC None8 21811 NC NC None2 21812 NC NC None8 21812 NC NC None2 21813 NC NC None8 21813 NC NC None

* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

Texas Medicaid Special Bulletin, No. 7 19 2015 HCPCS Special Bulletin

All Code Changes: Added, Revised, Replacement, and Discontinued

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

2 22510 * * NoneF 22510 * * None2 22511 * * NoneF 22511 * * None2 22512 * * NoneF 22513 * * None2 22514 * * NoneF 22514 * * None2 22515 * * None2 22858 NC NC None8 22858 NC NC None2 27279 NC NC None8 27279 NC NC NoneF 27279 NC NC None2 33270 NC NC NoneF 33270 NC NC None2 33271 NC NC NoneF 33271 NC NC None2 33272 NC NC None2 33273 NC NC NoneF 33273 NC NC None2 33418 NC NC None2 33419 NC NC None2 33946 * NC None MD2 33947 * NC None MD2 33948 * NC None MD2 33949 * NC None MD2 33951 * NC None MD2 33952 * NC None MD2 33953 * NC None MD2 33954 * NC None MD2 33955 * NC None MD2 33956 * NC None MD2 33957 * NC None MD* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

Texas Medicaid Special Bulletin, No. 7 20 2015 HCPCS Special Bulletin

All Code Changes: Added, Revised, Replacement, and Discontinued

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

2 33958 * NC None MD2 33959 * NC None MD2 33962 * NC None MD2 33963 * NC None MD2 33964 * NC None MD2 33965 * NC None MD2 33966 * NC None MD2 33969 * NC None MD2 33984 * NC None MD2 33985 * NC None MD2 33986 * NC None MD2 33987 * NC None MD2 33988 * NC None MD2 33989 * NC None MD2 34839 * * None2 37218 * * None2 43180 * * NoneF 43180 * * None2 44381 * * NoneF 44381 * * None2 44384 NC NC NoneF 44384 NC NC None2 44401 NC NC NoneF 44401 NC NC None2 44402 NC NC NoneF 44402 NC NC None2 44403 * * NoneF 44403 * * None2 44404 * * NoneF 44404 * * None2 44405 * * NoneF 44405 * * None2 44406 * * None MDF 44406 * * None MD

* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

Texas Medicaid Special Bulletin, No. 7 21 2015 HCPCS Special Bulletin

All Code Changes: Added, Revised, Replacement, and Discontinued

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

2 44407 * * None MD, CSHCNF 44407 * * None MD, CSHCN2 44408 * * NoneF 44408 * * None2 45346 * * NoneF 45346 * * None2 45347 * * NoneF 45347 * * None2 45349 * * NoneF 45349 * * None2 45350 * * NoneF 45350 * * None2 45388 * * NoneF 45388 * * None2 45389 * * NoneF 45389 * * None2 45390 * * NoneF 45390 * * None2 45393 * * NoneF 45393 * * None2 45398 * * NoneF 45398 * * None2 45399 NC NC None2 46601 NC NC None2 46607 NC NC NoneF 46607 NC NC None2 47383 * * NoneF 47383 * * None2 52441 NC NC None2 52442 NC NC None2 62302 * * None2 62303 * * None2 62304 * * None2 62305 * * None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

Texas Medicaid Special Bulletin, No. 7 22 2015 HCPCS Special Bulletin

All Code Changes: Added, Revised, Replacement, and Discontinued

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

2 64486 NC NC None2 64487 NC NC None2 64488 NC NC None2 64489 NC NC None2 66179 * * None8 66179 * * NoneF 66179 * * None2 66184 * * None8 66184 * * NoneF 66184 * * None4 76641 * * EPHC None MDI 76641 * * EPHC None MDT 76641 * * EPHC None MD4 76642 * * EPHC None MDI 76642 * * EPHC None MDT 76642 * * EPHC None MD4 77061 NC NC NoneI 77061 NC NC NoneT 77061 NC NC None4 77062 NC NC NoneI 77062 NC NC NoneT 77062 NC NC None4 77063 NC NC NoneI 77063 NC NC NoneT 77063 NC NC None4 77085 * * EPHC NoneI 77085 * * EPHC NoneT 77085 * * EPHC None4 77086 * * EPHC NoneI 77086 * * EPHC NoneT 77086 * * EPHC None6 77306 * * None CSHCNI 77306 * * None CSHCNT 77306 * * None CSHCN* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

Texas Medicaid Special Bulletin, No. 7 23 2015 HCPCS Special Bulletin

All Code Changes: Added, Revised, Replacement, and Discontinued

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

6 77307 * * None CSHCNI 77307 * * None CSHCNT 77307 * * None CSHCN6 77316 * * None MD, CSHCNI 77316 * * None MD, CSHCNT 77316 * * None MD, CSHCN6 77317 * * None MD, CSHCNI 77317 * * None MD, CSHCNT 77317 * * None MD, CSHCN6 77318 * * None MD, CSHCNI 77318 * * None MD, CSHCNT 77318 * * None MD, CSHCN6 77385 * * None CSHCN6 77386 * * None CSHCN6 77387 * * None CSHCNI 77387 * * None CSHCNT 77387 * * None CSHCN5 80163 * * EPHC None5 80165 * * EPHC None5 80300 * * EPHC None5 80301 * * EPHC None5 80302 * * EPHC None5 80303 * * EPHC None5 80304 * * EPHC None5 80320 * * EPHC None5 80321 * * EPHC None5 80322 * * EPHC None5 80323 * * EPHC None5 80324 * * EPHC None5 80325 * * EPHC None5 80326 * * EPHC None5 80327 * * EPHC None5 80328 * * EPHC None5 80329 * * EPHC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

Texas Medicaid Special Bulletin, No. 7 24 2015 HCPCS Special Bulletin

All Code Changes: Added, Revised, Replacement, and Discontinued

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

5 80330 * * EPHC None5 80331 * * EPHC None5 80332 * * EPHC None5 80333 * * EPHC None5 80334 * * EPHC None5 80335 * * EPHC None5 80336 * * EPHC None5 80337 * * EPHC None5 80338 * * EPHC None5 80339 * * EPHC None5 80340 * * EPHC None5 80341 * * EPHC NoneI 80341 * * EPHC NoneT 80341 * * EPHC None5 80342 * * EPHC NoneI 80342 * * EPHC NoneT 80342 * * EPHC None5 80343 * * EPHC None5 80344 * * EPHC None5 80345 * * EPHC None5 80346 * * EPHC None5 80347 * * EPHC None5 80348 * * EPHC None5 80349 * * EPHC None5 80350 * * EPHC None5 80351 * * EPHC None5 80352 * * EPHC None5 80353 * * EPHC None5 80354 * * EPHC None5 80355 * * EPHC None5 80356 * * EPHC None5 80357 * * EPHC None5 80358 * * EPHC None5 80359 * * EPHC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

Texas Medicaid Special Bulletin, No. 7 25 2015 HCPCS Special Bulletin

All Code Changes: Added, Revised, Replacement, and Discontinued

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

5 80360 * * EPHC None5 80361 * * EPHC None5 80362 * * EPHC None5 80363 * * EPHC None5 80364 * * EPHC None5 80365 * * EPHC None5 80366 * * EPHC None5 80367 * * EPHC None5 80368 * * EPHC None5 80369 * * EPHC None5 80370 * * EPHC None5 80371 * * EPHC None5 80372 * * EPHC None5 80373 * * EPHC None5 80374 * * EPHC None5 80375 * * EPHC None5 80376 * * EPHC None5 80377 * * EPHC None5 81246 * * None5 81288 * * None MD, CSHCN5 81313 * * None5 81410 * * None5 81411 * * None5 81415 NC NC None5 81416 NC NC None5 81417 NC NC None5 81420 NC NC EPHC None5 81425 NC NC None5 81426 NC NC None5 81427 NC NC None5 81430 NC NC None5 81431 NC NC None5 81435 NC NC None5 81436 NC NC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

Texas Medicaid Special Bulletin, No. 7 26 2015 HCPCS Special Bulletin

All Code Changes: Added, Revised, Replacement, and Discontinued

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

5 81440 NC NC None5 81445 NC NC None5 81450 NC NC None5 81455 NC NC None5 81460 NC NC None5 81465 NC NC None5 81470 NC NC None5 81471 NC NC None5 81519 * * None MD5 83006 * * EPHC None5 87505 * * EPHC None5 87506 * * EPHC None5 87507 * * EPHC None5 87623 * * EPHC None5 87624 * * EPHC None5 87625 * * EPHC None5 87806 * * EPHC None5 88341 * * EPHC None MDI 88341 * * EPHC None MDT 88341 * * EPHC None MD5 88344 * * EPHC None MDI 88344 * * EPHC None MDT 88344 * * EPHC None MD5 88364 * * None MDI 88364 * * None MDT 88364 * * None MD5 88366 * * None MDI 88366 * * None MDT 88366 * * None MD5 88369 * * None MDI 88369 * * None MDT 88369 * * None MD5 88373 * * None MDI 88373 * * None MD

* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

T 88373 * * None MD5 88374 * * None MDI 88374 * * None MDT 88374 * * None MD5 88377 * * None MDI 88377 * * None MDT 88377 * * None MD5 89337 NC NC None MD, CSHCN1 90630 * * None MD, CSHCNS 90630 * NC None1 90651 NC NC NoneS 90651 NC NC None5 91200 NC NC NoneI 91200 NC NC NoneT 91200 NC NC None5 92145 NC NC NoneI 92145 NC NC NoneT 92145 NC NC None2 93260 * * NoneI 93260 * * NoneT 93260 * * None2 93261 * * NoneI 93261 * * NoneT 93261 * * None4 93355 * * None2 93644 * * NoneI 93644 * * NoneT 93644 * * None1 93702 NC NC None4 93895 NC NC None1 96127 NC NC None1 97607 NC NC None1 97608 NC NC None1 99184 NC NC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

1 99188 NC NC None1 99490 NC NC None1 99497 NC NC None1 99498 NC NC None9 A4459 NC NC None9 A4602 * * None MD, CSHCN9 A7048 * * None9 A9606 * * None9 C2624 NC NC None9 C2644 NC NC None1 C9025 * * None1 C9026 * * None1 C9027 NC NC None1 C9136 * * None MD, CSHCN1 C9349 NC NC None1 C9442 * * None1 C9443 NC NC None1 C9444 NC NC None1 C9446 * * None1 C9447 NC NC None2 C9742 NC NC NoneW D0171 NC NC NoneW D0351 * * NoneW D1353 NC NC NoneW D6110 NC NC NoneW D6111 NC NC NoneW D6112 NC NC NoneW D6113 NC NC NoneW D6114 NC NC NoneW D6115 NC NC NoneW D6116 NC NC NoneW D6117 NC NC NoneW D6549 * * MD, CSHCN MD, CSHCNW D9219 NC NC NoneW D9931 NC NC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

W D9986 Informational Only

Informational Only

None

W D9987 * * None1 G0276 NC NC None1 G0277 * * MD, CSHCN MD, CSHCNI G0279 NC NC NoneT G0279 NC NC None5 G0464 NC NC None1 G0466 * * None1 G0467 * * None1 G0468 * * None1 G0469 * * None1 G0470 * * None5 G0471 NC NC None5 G0472 NC NC None1 G0473 NC NC None6 G6001 * * NoneI G6001 * * NoneT G6001 * * None6 G6002 * * None MD, CSHCNI G6002 * * None MD, CSHCNT G6002 * * None MD, CSHCN6 G6003 * * None6 G6004 * * None CSHCN6 G6005 * * None CSHCN6 G6006 * * None CSHCN6 G6007 * * None CSHCN6 G6008 * * None CSHCN6 G6009 * * None CSHCN6 G6010 * * None CSHCN6 G6011 * * None CSHCN6 G6012 * * None CSHCN6 G6013 * * None CSHCN6 G6014 * * None CSHCN

* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

6 G6015 * * None CSHCN6 G6016 * * None CSHCN6 G6017 * * None CSHCN2 G6018 * * None2 G6019 * * None2 G6020 * * None2 G6021 * * CSHCN MD2 G6022 NC NC None2 G6023 NC NC None2 G6024 NC NC None2 G6025 NC NC None2 G6027 * * None MD2 G6028 * * None MD5 G6030 NC NC None5 G6031 NC NC None5 G6032 NC NC None5 G6034 NC NC None5 G6035 NC NC None5 G6036 NC NC None5 G6037 NC NC None5 G6038 NC NC None5 G6039 NC NC None5 G6040 NC NC None5 G6041 NC NC None5 G6042 NC NC None5 G6043 NC NC None5 G6044 NC NC None5 G6045 NC NC None5 G6046 NC NC None5 G6047 NC NC None5 G6048 NC NC None5 G6049 NC NC None5 G6050 NC NC None5 G6051 NC NC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

5 G6052 NC NC None5 G6053 NC NC None5 G6054 NC NC None5 G6055 NC NC None5 G6056 NC NC None5 G6057 NC NC None5 G6058 NC NC None1 G9362 NC NC None1 G9363 NC NC None1 G9364 NC NC None1 G9365 NC NC None1 G9366 NC NC None1 G9367 NC NC None1 G9368 NC NC None1 G9369 NC NC None1 G9370 NC NC None1 G9376 NC NC None1 G9377 NC NC None1 G9378 NC NC None1 G9379 NC NC None1 G9380 NC NC None1 G9381 NC NC None1 G9382 NC NC None1 G9383 NC NC None1 G9384 NC NC None1 G9385 NC NC None1 G9386 NC NC None1 G9389 NC NC None1 G9390 NC NC None1 G9391 NC NC None1 G9392 NC NC None1 G9393 NC NC None1 G9394 NC NC None1 G9395 NC NC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

1 G9396 NC NC None1 G9399 NC NC None1 G9400 NC NC None1 G9401 NC NC None1 G9402 NC NC None1 G9403 NC NC None1 G9404 NC NC None1 G9405 NC NC None1 G9406 NC NC None1 G9407 NC NC None1 G9408 NC NC None1 G9409 NC NC None1 G9410 NC NC None1 G9411 NC NC None1 G9412 NC NC None1 G9413 NC NC None1 G9414 NC NC None1 G9415 NC NC None1 G9416 NC NC None1 G9417 NC NC None1 G9418 NC NC None1 G9419 NC NC None1 G9420 NC NC None1 G9421 NC NC None1 G9422 NC NC None1 G9423 NC NC None1 G9424 NC NC None1 G9425 NC NC None1 G9426 NC NC None1 G9427 NC NC None1 G9428 NC NC None1 G9429 NC NC None1 G9430 NC NC None1 G9431 NC NC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

1 G9432 NC NC None1 G9433 NC NC None1 G9434 NC NC None1 G9435 NC NC None1 G9436 NC NC None1 G9437 NC NC None1 G9438 NC NC None1 G9439 NC NC None1 G9440 NC NC None1 G9441 NC NC None1 G9442 NC NC None1 G9443 NC NC None1 G9448 NC NC None1 G9449 NC NC None1 G9450 NC NC None1 G9451 NC NC None1 G9452 NC NC None1 G9453 NC NC None1 G9454 NC NC None1 G9455 NC NC None1 G9456 NC NC None1 G9457 NC NC None1 G9458 NC NC None1 G9459 NC NC None1 G9460 NC NC None1 G9463 NC NC None1 G9464 NC NC None1 G9465 NC NC None1 G9466 NC NC None1 G9467 NC NC None1 G9468 NC NC None1 G9469 NC NC None1 G9470 NC NC None1 G9471 NC NC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

1 G9472 NC NC None1 J0153 NC NC None1 J0571 NC NC None1 J0572 NC NC None1 J0573 NC NC None1 J0574 NC NC None1 J0575 NC NC None1 J0887 NC NC None1 J0888 NC NC None1 J1071 * * None1 J1322 * * None1 J1439 * * None MD1 J2274 NC NC None1 J2704 NC NC None1 J3121 * * None1 J3145 * * None1 J7181 * * None MD, CSHCN1 J7182 NC NC None1 J7200 * * None MD, CSHCN1 J7201 * * None MD, CSHCN1 J7327 NC NC None1 J7336 NC NC None1 J9267 * * None1 J9301 * * None9 L3981 * * MD, CSHCN MD, CSHCN9 L6026 * * MD, CSHCN MD, CSHCN9 L7259 * * MD, CSHCN MD, CSHCN9 L8696 * * MD, CSHCN MD, CSHCN1 Q4150 NC NC None1 Q4151 NC NC None1 Q4152 NC NC None1 Q4153 NC NC None1 Q4154 NC NC None1 Q4155 NC NC None1 Q4156 NC NC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

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TOSProcedure Code

Medicaid Allowable

CSHCN Allowable

Other Allowable

Authorization Requirements

Benefit Changes

1 Q4157 NC NC None1 Q4158 NC NC None1 Q4159 NC NC None1 Q4160 NC NC None9 S1034 NC NC None9 S1035 NC NC None9 S1036 NC NC None9 S1037 NC NC None1 S9901 NC NC None* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit, MD in the Authorization Requirements column indicates that a Medicaid prior authorization is required. CSHCN in the Authorization Requirements column indicates that a CSHCN Services Program authorization or prior authorization is required. MC in the Authorization Requirements column indicates that a Medicaid managed care prior authorization is required. None in the Authorization Requirements column indicates that authorization or prior authorization is not required.MD in the Benefit Changes column indicates that additional information is available in the Medicaid program benefit changes section at the beginning of this bulletin. CSHCN in the Benefit Changes column indicates that additional information is available in the CSHCN Services Program benefit changes section at the beginning of this bulletin. If the Benefit Changes column is blank, no additional program information is available for the procedure code.

Note: All new, revised, and discontinued 2015 HCPCS procedure codes are effective for dates of service on or after January 1, 2015. The new procedure codes that are indicated with an asterisk (*) in the above table are pending a rate hearing and approval of expenditures. Providers will be notified in a future notification if a new procedure code is not approved for reimbursement. Providers can refer to the section in this bulletin titled Rate Hearings and Expenditure Review for more information about benefits that are pending approval of expenditures.

The following new procedure codes are used for reporting purposes and are informational only:Procedure CodesMedical Procedures0358T 0359T 0360T 0361T 0362T 0363T 0364T 0365T 0366T 0367T0368T 0369T 0370T 0371T 0372T 0373T 0374T 0378T 0379T 0380T0381T 0382T 0383T 0384T 0385T 0386T 0389T 0390T 0391T 3126F3775F 3776FSurgical Procedures0347T 0356T 0375T 0376T 0377T 0387T 0388TRadiological Procedures0348T 0349T 0350T 0351T 0353T 0355TLaboratory Procedures0001M 0002M 0003M 0004M 0006M 0007M 0008MOther DME Procedure0357TProfessional Component Procedures0352T 0354T

For more information, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 1­800­925­9126 or the TMHP­CSHCN Services Program Contact Center at 1­800­568­2413.

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Discontinued Procedure CodesThe 2015 HCPCS discontinued procedure codes are no longer reimbursed after December 31, 2014. The following is a list of procedure codes that have been discontinued: Procedure Codes00452 00622 00634 21800 21810 22520 22521 22522 22523 2252422525 29020 29025 29715 33332 33472 33960 33961 36469 3682242508 43350 44383 44393 44397 45339 45345 45355 45383 4538761334 61440 61470 61490 61542 61609 61875 62116 64752 6476164870 66165 69400 69401 69405 72291 72292 74291 76645 7695077082 77305 77310 77315 77326 77327 77328 77403 77404 7740677408 77409 77411 77413 77414 77416 77418 77421 80100 80101*80102 80103 80104 80152 80154 80160 80166 80172 80174 8018280196 80440 82000 82003 82055 82101 82145 82205 82520 8264682649 82651 82654 82666 82690 82742 82953 82975 82980 8300883055 83071 83634 83805 83840 83858 83866 83887 83925 8402284127 87001 87620 87621 87622 88343 88349 99481 99482 99488A7042 A7043 C1300* C9021 C9022* C9023* C9133* C9134* C9135* C9441C9735 D6053 D6054 D6078 D6079 D6975 G0173 G0251 G0417 G0418G0419 G0456 G0457 G0461 G0462 G0908 G0909 G0910 G0919 G0920G0921 G0922 G8126 G8127 G8128 G8406 G8464 G8492 G8493 G8501G8502 G8547 G8552 G8579 G8580 G8581 G8582 G8583 G8584 G8585G8586 G8587 G8593 G8594 G8595 G8597 G8629 G8630 G8631 G8632G8682 G8683 G8685 G8699 G8700 G8701 G8702 G8703 G8704 G8705G8706 G8707 G8736 G8737 G8738 G8739 G8740 G8751 G8763 G8764G8767 G8768 G8769 G8770 G8771 G8772 G8773 G8774 G8775 G8776G8777 G8778 G8779 G8780 G8781 G8782 G8859 G8860 G8862 G8886G8887 G8888 G8889 G8890 G8891 G8892 G8893 G8894 G8895 G8896G8897 G8904 G8905 G8930 G8931 G8932 G8933 G8943 G8949 G8957G9193 G9194 G9195 G9199 G9200 G9201 G9202 G9214 G9215 G9216G9218 G9220 G9221 G9224 G9248 G9249 G9252 G9253 G9271 G9272J0150 J0151 J0900 J1060 J1070 J1080 J2271 J2275 J3120 J3130J3140 J3150 J7335 J9265 L6025 L7260 L7261 M0064 Q9970 Q9972*Q9973* Q9974* S0144* S3855

The procedure codes indicated with an asterisk (*) have been replaced. Replacement procedure codes are available for the Texas Medicaid Program, the CSHCN Services Program, or both. Providers may refer to the Replacement Procedure Codes Section on page 38 of this bulletin for details.

The following informational reporting procedure codes have been discontinued:Procedure Codes0005M 0059T 0073T 0092T 0181T 0197T 0199T 0226T 0227T 0239T0245T 0246T 0247T 0248T 0319T 0320T 0321T 0322T 0323T 0324T0325T 0326T 0327T 0328T 0334T 0343T 0344T 3125F

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All Code Changes: Added, Revised, Replacement, and Discontinued

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For more information, call the TMHP Contact Center at 1­800­925­9126 or the TMHP­CSHCN Services Program Contact Center at 1­800­568­2413.

Replacement Procedure CodesEffective for dates of service on or after January 1, 2015, the following discontinued procedure codes will be replaced by the corresponding replacement procedure codes:

Replacement CodesDiscontinued Codes Medicaid Rate CSHCN Rate

Authorization Requirement

G0277 C1300 * * MD, CSHCNG0431 80101 $15.90 * NoneJ0887 Q9972 NC NC NoneJ0888 Q9973 NC NC NoneJ1322 C9022 * * NoneJ2274 Q9974 NC NC NoneJ2704 S0144 NC NC NoneJ3145 C9023 * * NoneJ7181 C9134 * * NoneJ7200 C9133 $1.71 $1.05 NoneJ7201 C9135 * * None

* = Texas Medicaid rate hearing required, NC = Procedure code not a benefit

For more information, call the TMHP Contact Center at 1­800­925­9126 or the TMHP­CSHCN Services Program Contact Center at 1­800­568­2413.

Procedure Code Description ChangesEffective for dates of service on or after January 1, 2015, the following procedure code descriptions have changed:Procedure Codes20600 20605 20610 20982 27280 27370 33215 33218 33220 3322333224 33225 33230 33231 33240 33241 33243 33244 33249 3326233263 33264 37215 37216 37217 43194 43197 43215 43216 4324744360 44363 44380 44382 44385 44386 44388 44389 44390 4439144392 44799 45330 45332 45333 45334 45337 45340 45378 4537945380 45381 45382 45384 45385 45386 45391 45392 46600 6105562284 66180 66185 67399 77401 77402 77407 77412 80162 8016480171 80299 81245 82541 82542 82543 82544 84600 86900 8690186902 86904 86905 86906 87501 87502 87503 87631 87632 8763388342 88360 88361 88365 88367 88368 90654 90723 90734 9328293283 93284 93287 93289 93295 93296 93642 95972 96110 9760597606 99487 99489 A4601 C9741 D0350 D0481 D1208 D1550 D2910D2915 D2920 D3351 D4260 D4261 D6092 D6093 D6101 D6102 D6103D6194 D6930 D7285 D7286 D7292 D7293 D7294 D8660 D8670 D8693D9241 D9242 D9248 E0856 E0986 G0204 G0206 G0416 G8461 G8474

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All Code Changes: Added, Revised, Replacement, and Discontinued

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Procedure CodesG8476 G8477 G8483 G8484 G8571 G8572 G8720 G8840 G8843 G8861G8876 G8924 G8936 G8968 G9160 G9163 G9166 G9169 G9172 G9175G9186 G9210 G9242 G9277 G9278 G9296 G9297 G9298 G9299 G9303G9304 G9329 G9340 G9341 G9342 G9343 G9344 G9345 G9346 G9347J7195 J7301 L7367 Q4119 Q4147 S0183 V2799

The descriptions of the following informational reporting procedure codes have changed:Reporting Procedure Codes - Informational4256F 0075T 0076T

Providers must contact the appropriate copyright holder to obtain procedure code descriptions.

For more information, call the TMHP Contact Center at 1­800­925­9126 or the TMHP­CSHCN Services Program Contact Center at 1­800­568­2413.

ModifiersThe following table lists new, revised, and discontinued modifiers:New ModifiersXE XSRevised ModifiersPO XP XU

New modifiers are effective for dates of service on or after January 1, 2015. Providers may contact the appropriate copyright holder to obtain modifier descriptions.

PRIOR AUTHORIZATION CHANGES

Authorization or Prior AuthorizationFor procedure codes that require authorization or prior authorization but are awaiting a rate hearing and approval of expenditures, providers must follow the established authorization or prior authorization processes as defined in the following:

• Current Texas Medicaid Provider Procedures Manual

• Current CSHCN Services Program Provider Manual

• Articles published on the Texas Medicaid & Healthcare Partnership (TMHP) web page at www.tmhp.com

Providers must obtain a timely authorization or prior authorization for the service that they provide. Services that are submitted without the proper authorization will be denied.

Providers are responsible for meeting all filing deadlines and for ensuring that the authorization or prior authoriza­tion number appears on the claim or that the appropriate documentation is submitted with the claim. Retroactive authorization requests for certain services will not be granted, unless otherwise indicated in the applicable autho­

Texas Medicaid Special Bulletin, No. 7 39 2015 HCPCS Special Bulletin

Prior Authorization Changes

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Page 40: HCPCS Special Bulletin - TMHPJANUARY 2015 NO. 7. 2015 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin HCPCS Special Bulletin

rization requirements sections of the current Texas Medicaid Provider Procedures Manual, or the current CSHCN Services Program Provider Manual.

The procedure codes that require authorization or prior authorization are indicated in the Authorization Require­ments column of the 2015 HCPCS Procedure Code Additions table that begins on page 19 of this bulletin.

Important: Authorization or prior authorization is a condition for reimbursement; it is not a guarantee of payment.

Prior Authorization UpdateProviders who have received prior authorization for any of the following 2015 Healthcare Common Procedure Coding System (HCPCS) discontinued procedure codes for dates of service that occur on, after, or encompass January 1, 2015, must contact the TMHP Prior Authorization Department to update the procedure codes that are prior authorized for those services:TOS Discontinued Procedure Code Prior Authorization Requirements2/8/F 61875 MD, CSHCN2/8 62116 CSHCN6/I/T 77421 MD, CSHCN1 C1300 MD, CSHCNW D6975 MD, MC, CSHCN6 G0251 MD, CSHCN9 L6025 CSHCN9 L7260 CSHCN9 L7261 CSHCNTOS = Type of service, CSHCN = Prior authorization required for the CSHCN Services Program, MD = Prior authorization required for Texas Medicaid, MC = Managed care prior authorization required.

Replacement procedure codes listed in the following table will be updated by TMHP and require no action on the part of the provider:

Procedure Code ProgramC1300 MD, CSHCNMD = Prior authorization required for Texas Medicaid, CSHCN = Prior authorization required for the CSHCN Services Program.

For a list of Prior Authorization Department telephone numbers, providers may refer to the “TMHP Telephone and Address Guide” in the current Texas Medicaid Provider Procedures Manual, Vol. 1, (General Information), on page vii, and TMHP­CSHCN Services Program Contact Information” in the current CSHCN Services Program Provider Manual, on page 1­2.

Texas Medicaid Special Bulletin, No. 7 40 2015 HCPCS Special Bulletin

Prior Authorization Changes

CPT only copyright 2014 American Medical Association. All rights reserved.