2014 HCPCS Annual Update

Transcription

1 2014 HCPCS Annual Update Information posted December 31, 2013 Note: This article applies to claims submitted to TMHP for processing. For claims processed by a managed care organization (MCO), providers must refer to the MCO for information about benefits, limitations, and reimbursement. On January 1, 2014, TMHP will apply the 2014 annual Healthcare Common Coding System (HCPCS) updates that are effective for dates of service on or after January 1, Deleted procedure codes will no longer be benefits of Texas or the Children with Special Health Care Needs () s Program. The new procedure codes that are designated with asterisks (*) in the Texas and the s Program columns of the table must complete the rate hearing process, and expenditures must be approved before the rates are adopted by Texas and the s Program. Providers will be notified in a future notification if any procedure codes will not be reimbursed because the expenditures were not approved. Note: Benefit changes related to HCPCS 2014 updates will be published in a special bulletin in February Providers may refer to the following resources for more information about the public rate hearings and approval of expenditures: Title 2 Human Resources, , and Title 1 Texas Administrative (TAC), , which require public hearings House Bill 1, 80th Legislature, Regular Session, 2007, Article II, Department of State Health s, Rider 79a Important: To avoid fraudulent billing, providers must submit the procedure codes that are most appropriate for the services provided. and Prior Update Reminder Effective January 1, 2014, the 2014 HCPCS deleted procedure codes are no longer reimbursed by Texas or s Program. Providers who have received prior authorization or authorization for dates of service that occur on, after, or encompass January 1, 2014, must submit a written request on the appropriate, completed Texas prior authorization request form or s Program authorization or prior authorization request form in order to update the HCPCS procedure codes authorized for those services. All Changes: Added, Revised, Replacement, and Discontinued 2014 HCPCS Additions The following is a list of new HCPCS procedure codes that do not replace existing codes: Type of * * None F * * None

2 * * None F * * None * * None * * None F * * None * * None * * None F * * None * * None * * None F * * None * * None * * None F * * None * * None * * None F * * None * * None * * None F * * None * * None * * None F * * None * * None F * * None * * None * * None * * None * * None * * None * * None * * None * * None * * None * * None

3 * * None * * None F * * None * * None * * None F * * None * * None * * None F NC NC None * * None * * None * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None

4 F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None * * None F * * None

5 * * None * * None F * * None * * None * * None F * * None * * None F * * None * * None * * None F * * None 6/I/T * * None * * None * * None * * None * * None * * None * * None * * None * * None * * None * * None * * None * * None * NC None * * None NC NC None 1/S * * None * * None * * None * * None * * None * * None * * None NC NC None

6 NC NC None NC NC None NC NC None NC NC None NC NC None NC NC None NC NC None 9 A4555 NC NC None 9 A7047 NC None 9 A9520 Informational only 9 A9575 Informational only 9 A9599 Informational only Informational only Informational only Informational only None None None 2 C5271 NC NC None 2 C5272 NC NC None 2 C5273 NC NC None 2 C5274 NC NC None 2 C5275 NC NC None 2 C5276 NC NC None 2 C5277 NC NC None 2 C5278 NC NC None 1 C9133 * * None 1 C9441 NC NC None 1 C9497 NC NC None 2 C9735 * * None F C9735 * * None 2 C9737 NC NC None W D0393 NC NC None W D0394 NC NC None W D0395 NC NC None W D0601 Informational Only W D0602 Informational Only Informational Only Informational Only None None W D0603 Informational Informational None

7 Only Only W D1999 NC NC None W D2921 NC NC None W D2941 NC NC None W D2949 NC NC None W D3355 NC NC None W D3356 NC NC None W D3357 NC NC None W D3427 NC NC None W D3428 NC NC None W D3429 NC NC None W D3431 NC NC None W D3432 NC NC None W D4921 NC NC None W D5863 * * None W D5864 * * None W D5865 * * None W D5866 * * None W D5994 NC NC None W D6011 NC NC None W D6013 NC NC None W D6052 NC NC None W D8694 NC NC None W D9985 NC NC None 9/J E0766 NC NC None J E1352 NC NC None 5 G0461 NC NC None 5 G0462 NC NC None 1 G0463 NC NC None 1 G9187 NC NC None 1 G9188 NC NC None 1 G9189 NC NC None 1 G9190 NC NC None 1 G9191 NC NC None 1 G9192 NC NC None 1 G9193 NC NC None

8 1 G9194 NC NC None 1 G9195 NC NC None 1 G9196 NC NC None 1 G9197 NC NC None 1 G9198 NC NC None 1 G9199 NC NC None 1 G9200 NC NC None 1 G9201 NC NC None 1 G9202 NC NC None 1 G9203 NC NC None 1 G9204 NC NC None 1 G9205 NC NC None 1 G9206 NC NC None 1 G9207 NC NC None 1 G9208 NC NC None 1 G9209 NC NC None 1 G9210 NC NC None 1 G9211 NC NC None 1 G9212 NC NC None 1 G9213 NC NC None 1 G9214 NC NC None 1 G9215 NC NC None 1 G9216 NC NC None 1 G9217 NC NC None 1 G9218 NC NC None 1 G9219 NC NC None 1 G9220 NC NC None 1 G9221 NC NC None 1 G9222 NC NC None 1 G9223 NC NC None 1 G9224 NC NC None 1 G9225 NC NC None 1 G9226 NC NC None 1 G9227 NC NC None 1 G9228 NC NC None

9 1 G9229 NC NC None 1 G9230 NC NC None 1 G9231 NC NC None 1 G9232 NC NC None 1 G9233 NC NC None 1 G9234 NC NC None 1 G9235 NC NC None 1 G9236 NC NC None 1 G9237 NC NC None 1 G9238 NC NC None 1 G9239 NC NC None 1 G9240 NC NC None 1 G9241 NC NC None 1 G9242 NC NC None 1 G9243 NC NC None 1 G9244 NC NC None 1 G9245 NC NC None 1 G9246 NC NC None 1 G9247 NC NC None 1 G9248 NC NC None 1 G9249 NC NC None 1 G9250 NC NC None 1 G9251 NC NC None 1 G9252 NC NC None 1 G9253 NC NC None 1 G9254 NC NC None 1 G9255 NC NC None 1 G9256 NC NC None 1 G9257 NC NC None 1 G9258 NC NC None 1 G9259 NC NC None 1 G9260 NC NC None 1 G9261 NC NC None 1 G9262 NC NC None 1 G9263 NC NC None

10 1 G9264 NC NC None 1 G9265 NC NC None 1 G9266 NC NC None 1 G9267 NC NC None 1 G9268 NC NC None 1 G9269 NC NC None 1 G9270 NC NC None 1 G9271 NC NC None 1 G9272 NC NC None 1 G9273 NC NC None 1 G9274 NC NC None 1 G9275 NC NC None 1 G9276 NC NC None 1 G9277 NC NC None 1 G9278 NC NC None 1 G9279 NC NC None 1 G9280 NC NC None 1 G9281 NC NC None 1 G9282 NC NC None 1 G9283 NC NC None 1 G9284 NC NC None 1 G9285 NC NC None 1 G9286 NC NC None 1 G9287 NC NC None 1 G9288 NC NC None 1 G9289 NC NC None 1 G9290 NC NC None 1 G9291 NC NC None 1 G9292 NC NC None 1 G9293 NC NC None 1 G9294 NC NC None 1 G9295 NC NC None 1 G9296 NC NC None 1 G9297 NC NC None 1 G9298 NC NC None

11 1 G9299 NC NC None 1 G9300 NC NC None 1 G9301 NC NC None 1 G9302 NC NC None 1 G9303 NC NC None 1 G9304 NC NC None 1 G9305 NC NC None 1 G9306 NC NC None 1 G9307 NC NC None 1 G9308 NC NC None 1 G9309 NC NC None 1 G9310 NC NC None 1 G9311 NC NC None 1 G9312 NC NC None 1 G9313 NC NC None 1 G9314 NC NC None 1 G9315 NC NC None 1 G9316 NC NC None 1 G9317 NC NC None 1 G9318 NC NC None 1 G9319 NC NC None 1 G9320 NC NC None 1 G9321 NC NC None 1 G9322 NC NC None 1 G9323 NC NC None 1 G9324 NC NC None 1 G9325 NC NC None 1 G9326 NC NC None 1 G9327 NC NC None 1 G9328 NC NC None 1 G9329 NC NC None 1 G9340 NC NC None 1 G9341 NC NC None 1 G9342 NC NC None 1 G9343 NC NC None

12 1 G9344 NC NC None 1 G9345 NC NC None 1 G9346 NC NC None 1 G9347 NC NC None 1 G9348 NC NC None 1 G9349 NC NC None 1 G9350 NC NC None 1 G9351 NC NC None 1 G9352 NC NC None 1 G9353 NC NC None 1 G9354 NC NC None 1 G9355 NC NC None 1 G9356 NC NC None 1 G9357 NC NC None 1 G9358 NC NC None 1 G9359 NC NC None 1 G9360 NC NC None 1 J0151 * * None 1 J0401 * * None 1 J0717 * * None 1 J1442 * * None 1 J1446 NC NC None 1 J1602 * * None 1 J3489 * * None 1 J7508 NC NC None 1 J9047 NC NC None 1 J9354 NC NC None 1 J9371 * * None 9 L0455 * * MD-CCP,, MC 9 L0457 * * MD-CCP,, MC 9 L0467 * * MD-CCP,, MC 9 L0469 * * MD-CCP,, MC 9 L0641 * * MD-CCP,, MC 9 L0642 * * MD-CCP,, MC 9 L0643 * * MD-CCP,, MC

13 9 L0648 * * MD-CCP,, MC 9 L0649 * * MD-CCP,, MC 9 L0650 * * MD-CCP,, MC 9 L0651 * * MD-CCP,, MC 9 L1812 * * MD-CCP,, MC 9 L1833 * * MD-CCP,, MC 9 L1848 * * MD-CCP,, MC 9 L3678 * * MD-CCP,, MC 9 L3809 * * MD-CCP,, MC 9 L3916 * * MD-CCP,, MC 9 L3918 * * MD-CCP,, MC 9 L3924 * * MD-CCP,, MC 9 L3930 * * MD-CCP,, MC 9 L4361 * * MD-CCP,, MC 9 L4387 * * MD-CCP,, MC 9 L4397 * * MD-CCP,, MC 9 L5969 NC NC None 9 L8679 NC NC None 1 Q0161 NC NC None 1 Q2028 NC NC None 9 Q2052 NC NC None 1 Q3027 * * None 1 Q3028 * * None 1 Q4137 * * None 1 Q4138 * * None 1 Q4139 NC NC None 1 Q4140 * * None 1 Q4141 * * None 1 Q4142 * * None 1 Q4143 * * None 1 Q4145 NC NC None 1 Q4146 * * None 1 Q4147 * * None 1 Q4148 * * None 1 Q4149 * * None

14 9 S9960 NC NC None 9 S9961 NC NC None 9 T4544 * * None * = Texas rate hearing required NC = code not a benefit MD in the column indicates that a prior authorization is required. in the column indicates that a s Program authorization or prior authorization is required. MC in the column indicates that a managed care prior authorization is required. None in the column indicates that authorization or prior authorization is not required. The following new procedure codes are used for reporting purposes and are informational only: s Medical s 0329T 0330T 0331T 0332T 0333T 0337T 0346T 9001F 9002F 9003F 9004F 9005F 9006F 9007F Surgical s 0334T 0335T 0336T 0338T 0339T 0340T 0341T 0342T 0343T 0344T 0345T Discontinued s The 2014 HCPCS discontinued procedure codes are no longer reimbursed after December 31, The following is a list of procedure codes that have been discontinued: s C1204 C1879 C9130* C9131 C9292* C9294* C9295 C9296* C9297* C9298* C9736 D0363 D3354 D5860 D5861 G0275 G8459 G8462 G8463 G8553 G8556 G8557 G8558 G8588 G8589 G8590 G8591 G8592 G8596 G8603 G8604 G8605 G8606 G8607 G8608 G8609 G8610 G8611 G8612 G8613 G8614 G8615 G8616 G8617 G8618 G8619 G8620 G8621 G8622 G8623 G8624 G8625 G8626 G8642 G8643 G8644 G8741 G8742 G8743 G8744 G8745 G8746 G8747 G8748 G8790 G8791 G8792 G8793 G8794 G8795 G8796 G8799 G8800 G8801 G8812 G8813 G8814 G8827 G8835

15 s G8919 G8920 G8921 G8922 G8945 G8954 J0152 J0718 J1440 J1441 J3487 J3488 J9002 L0430 Q0090* Q0165 Q0168 Q0170 Q0171 Q0172 Q0176 Q0178 Q0505 Q2027 Q2051 Q3025 Q3026 S3625 S3626 S3833 S3834 The procedure codes indicated with an asterisk (*) have been replaced. Replacement procedure codes are available for Texas, the s Program, or both. Providers may refer to the Replacement s section article for details. The following informational reporting procedure codes have been discontinued: s 0078T 0079T 0080T 0081T 0124T 0183T 0185T 0186T 0192T 0260T 0261T 0318T Replacement s Effective for dates of service on or after January 1, 2014, the following discontinued procedure codes will be replaced by the corresponding replacement procedure codes: Replacement s Discontinued s Rate Rate J1556 C9130 $64.42 $64.42 None J3060 C9294 $31.31 $31.31 None J7301 Q0090 $ $ None J7316 C9298 $ $ None J9262 C9297 $2.86 $2.86 None J9306 C9292 $98.98 $98.98 None J9400 C9296 * * None * = Texas rate hearing required Description Changes Requirement Effective for dates of service on or after January 1, 2014, the following procedure code descriptions have changed: s

16 s A5081 A9272 C2618 C9734 D0350 D2950 D3351 D3352 D3410 D3421 D3425 D3426 D4920 D5991 D6080 D8693 D9210 E0601 E2300 E2301 G0416 G0417 G0418 G0419 G8126 G8127 G8417 G8418 G8419 G8420 G8421 G8422 G8427 G8428 G8430 G8431 G8433 G8442 G8451 G8509 G8510 G8511 G8535 G8539 G8540 G8542 G8543 G8569

17 s G8570 G8682 G8683 G8685 G8709 G8722 G8730 G8731 G8733 G8768 G8772 G8775 G8778 G8781 G8784 G8808 G8810 G8880 G8882 G8887 G8891 G8892 G8928 G8929 G8938 G8939 G8940 G8941 G8942 G8946 G8950 G8951 G8968 G8969 G8985 G8990 G8991 G8992 G8993 G8994 G8995 G8996 G8997 G8998 G8999 G9158 G9159 G9160 G9161 G9162 G9163 G9164 G9165 G9166 G9167 G9168 G9169 G9170 G9171 G9172 G9173 G9174 G9175 G9176 G9186 J7507 L0120 L0160 L0172 L0174 L0450 L0454 L0456 L0460 L0466 L0468 L0621 L0623 L0625 L0626 L0627 L0628 L0630 L0631 L0633 L0637 L0639 L0980 L0982 L0984 L1600 L1610 L1620 L1810 L1830 L1832 L1836 L1843 L1845 L1847 L1850 L1902 L1904 L1906 L1907 L3100 L3170 L3650 L3660 L3670 L3675 L3677 L3710 L3762 L3807 L3908 L3912 L3915 L3917 L3923 L3925 L3927 L3929 L4350 L4360 L4370 L4386 L4396 L4398 L5668 Q5001 Q5002 Q5009 S0182 S3870 T4543 The descriptions of the following informational reporting procedure codes have changed: Reporting s - Informational 0001F 0005F 0012F 0014F 0015F T 0222T 0240T 0241T 0326T 0500F 0501F 0502F 0503F 0505F 0507F 0509F 0513F 0514F 0516F 0517F 0518F 0519F 0520F 0521F 0525F 0526F 0528F 0529F 0535F 0540F 0545F 0550F 0551F 0555F 0556F 0557F 0575F 0580F 0581F 0582F 0583F 0584F 1000F 1002F 1003F 1004F 1005F 1006F 1007F 1008F 1010F 1011F 1012F 1015F 1018F 1019F 1022F 1026F 1030F 1031F 1032F 1033F 1034F 1035F 1036F 1038F 1039F 1040F 1050F 1052F 1055F 1060F 1061F 1065F 1066F 1070F 1071F 1090F 1091F 1100F 1101F 1110F 1111F 1116F 1118F 1119F 1121F 1123F 1124F 1125F 1126F 1127F 1128F 1130F 1134F 1135F 1136F 1137F 1150F 1151F 1152F 1153F 1157F 1158F 1159F 1160F 1170F 1175F 1180F 1181F 1182F 1183F 1200F 1205F 1220F 1400F 1450F 1451F 1460F 1461F 1490F 1493F 1494F 1500F 1501F 1502F 1503F 1504F 1505F 2000F 2001F 2002F 2004F 2010F 2014F 2015F 2016F 2018F 2019F 2020F 2021F 2022F 2024F 2026F 2027F 2029F 2030F 2031F 2035F 2040F 2044F 2050F 2060F 3006F 3008F 3011F 3014F 3015F 3016F 3017F 3018F 3019F 3020F 3021F 3022F 3023F 3025F 3027F 3028F 3035F 3037F 3038F 3040F 3042F 3044F 3045F 3046F 3048F 3049F 3050F 3055F 3056F 3060F 3061F 3062F 3066F 3072F 3073F 3074F 3075F 3077F 3078F 3079F 3080F 3082F 3083F 3084F 3085F

18 Reporting s - Informational 3088F 3089F 3090F 3091F 3093F 3095F 3096F 3100F 3110F 3111F 3112F 3115F 3117F 3118F 3119F 3120F 3125F 3130F 3132F 3140F 3141F 3142F 3150F 3155F 3160F 3170F 3200F 3210F 3215F 3230F 3250F 3260F 3265F 3267F 3268F 3269F 3270F 3271F 3272F 3273F 3274F 3278F 3279F 3280F 3281F 3284F 3285F 3288F 3290F 3291F 3292F 3293F 3294F 3300F 3301F 3315F 3316F 3317F 3318F 3319F 3320F 3321F 3322F 3323F 3324F 3325F 3328F 3330F 3331F 3340F 3341F 3342F 3343F 3344F 3345F 3350F 3351F 3352F 3353F 3354F 3370F 3372F 3374F 3376F 3378F 3380F 3382F 3384F 3386F 3388F 3390F 3394F 3395F 3450F 3451F 3452F 3455F 3470F 3471F 3472F 3475F 3476F 3491F 3494F 3495F 3496F 3497F 3498F 3510F 3511F 3512F 3513F 3514F 3515F 3517F 3520F 3550F 3551F 3552F 3555F 3570F 3572F 3573F 3650F 3700F 3720F 3725F 3750F 3751F 3752F 3753F 3754F 3755F 3756F 3757F 3758F 3759F 3760F 3761F 3762F 3763F 4000F 4001F 4003F 4004F 4005F 4008F 4010F 4011F 4012F 4013F 4014F 4015F 4016F 4017F 4018F 4019F 4025F 4030F 4033F 4035F 4037F 4040F 4042F 4043F 4044F 4045F 4046F 4047F 4048F 4049F 4050F 4051F 4052F 4053F 4054F 4055F 4056F 4058F 4060F 4062F 4063F 4064F 4065F 4066F 4067F 4069F 4073F 4075F 4077F 4079F 4084F 4086F 4090F 4095F 4100F 4110F 4115F 4120F 4124F 4130F 4131F 4132F 4133F 4134F 4135F 4136F 4140F 4142F 4144F 4148F 4151F 4155F 4157F 4163F 4164F 4165F 4167F 4168F 4169F 4171F 4172F 4174F 4175F 4176F 4177F 4178F 4179F 4180F 4181F 4182F 4185F 4186F 4187F 4188F 4189F 4190F 4191F 4192F 4193F 4194F 4195F 4196F 4200F 4201F 4210F 4220F 4221F 4230F 4240F 4242F 4245F 4248F 4250F 4255F 4256F 4260F 4261F 4265F 4266F 4267F 4268F 4269F 4270F 4271F 4274F 4279F 4280F 4290F 4293F 4300F 4301F 4305F 4306F 4320F 4322F 4324F 4325F 4326F 4328F 4330F 4340F 4350F 4400F 4450F 4470F 4480F 4481F 4500F 4510F 4525F 4526F 4540F 4541F 4550F 4551F 4552F 4553F 4554F 4555F 4556F 4557F 4558F 4559F 4560F 4561F 4562F 4563F 5005F 5010F 5015F 5020F 5050F 5060F 5062F 5100F 5200F 5250F 6005F 6010F 6015F 6020F 6030F 6040F 6045F 6070F 6080F 6090F 6100F 6101F 6102F 6110F 6150F 7010F 7020F 7025F Providers must contact the appropriate copyright holder to obtain procedure code descriptions.

19 Modifiers The following table lists new, revised, and discontinued modifiers: Revised Modifiers HI PM New modifiers are effective for dates of service on or after January 1, Providers may contact the appropriate copyright holder to obtain modifier descriptions. or Prior For 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 Provider s Manual Current s Program Provider Manual Articles published on this website Providers must obtain a timely authorization or prior authorization for the service that they provide. s 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. For Texas, retroactive authorization requests for certain services will not be granted unless otherwise indicated in the applicable authorization requirements sections of the current Texas Provider s Manual. The procedure codes that require authorization or prior authorization are indicated in the column of the 2014 HCPCS Additions table. Important: or prior authorization is a condition for reimbursement; it is not a guarantee of payment. For more information, call the TMHP Contact Center at or the TMHP- s Program Contact Center at