Public Hearing Notice Proposed Medicaid Payment Rates for the Medicaid Biennial Calendar Fee Reviews, Medical Policy Reviews, Healthcare Common Procedure Coding System (HCPCS) Reviews, and Special Policy Review

May 16, 2022 - 9:00 am

John H Winters Building, Public Hearing Room 125
701 W 51st Street, Austin, TX
United States

Hearing.  The Texas Health and Human Services Commission (HHSC) will conduct a public hearing to receive public comments on proposed Medicaid payment rates for Biennial Calendar Fee Reviews, Medical Policy Reviews, Healthcare Common Procedure Coding System (HCPCS) Reviews, and Special Policy Review.

Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted both in-person and as an online event. To join the hearing from your computer, tablet, or smartphone, register for the hearing in advance using the following link:

Registration URL:

Webinar ID: 501-375-475

Conference Number (for those who use phone Audio and not a computer): (631) 992-3221

Phone Audio Passcode: 955-766-486

Audio PIN: (Please note, in order to receive a PIN to speak, registration is     required.)

The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements. A recording of the hearing will be archived and can be accessed on demand at                                

Members of the public may attend the rate hearing in person, which will be held in the Public Hearing Room 125 in the John H Winters Building located at 701 W 51st Street, Austin, Texas or may access a live stream of the meeting here. For the live stream, select the “Winters Live” tab.

Proposal.  The effective date of the proposed payment rates for the topics presented during the rate hearing will be as follows:

Effective January 1, 2022

HCPCS Review

Surgery, Assistant Surgery Services – TOS 2 (Surgery Services), and TOS 8 (Assistant Surgery)

Effective June 1, 2022

 Medical Policy Review

Physician Administered Drugs: Zyvox (J2020)
Physician Administered Drugs: Anavip (J0841)

Effective September 1, 2022

Calendar fee Review

Birthing Center
Cardiovascular System Surgery
Digestive System Surgery
G Codes (Acute Care)
G Codes (Hospitals)
K Codes
Nervous System Surgery
Physician Administered Drugs: NDCX
Physician Administered Drugs: Non-Oncology
Physician Administered Drugs: Oncology
Physician Administered Vaccines and Toxoids
Proton Therapy
Respiratory System Surgery
T Codes
Urinary System Surgery
Vision Devices
Personal Care Services

HCPCS Review

Quarter 3 HCPCS Drugs
Quarter 4 HCPCS Drugs

Medical Policy Review

Wound Care Management
Wound Care Skin Substitutes
Physician Administered Drugs: Ajovy (J3031)

Special Review

Nuclear Medicine

Methodology and Justification. The proposed payment rates were calculated in accordance with Title 1 of the Texas Administrative Code

Section §355.8021, Reimbursement Methodology for Home Health Services;

Section §355.8085, Reimbursement Methodology for Physicians and Other Practitioners;

Section §355.8441, Reimbursement Methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services, also known as Texas Health Steps (THSteps) and the THSteps Comprehensive Care Program (CCP);

Section §355.8181, Reimbursement methodology for Birthing Center reimbursement;

Section §355.8061, Reimbursement for outpatient hospitals;
Section §355.8121, Reimbursement for ambulatory surgical centers; and
Section §355.8660, Reimbursement Methodology for Renal Dialysis.

Rate Hearing Packet.  A briefing packet describing the proposed payment rates will be made available at on or after May 6, 2022. Interested parties may obtain a copy of the briefing packet on or after that date by contacting Provider Finance by telephone at (512) 730-7401; by fax at (512) 730-7475; or by e-mail at

Written Comments.  Written comments regarding the proposed payment rates may be submitted instead of, or in addition to, oral testimony until 5 p.m. the day of the hearing. Written comments may be sent by U.S. mail, overnight mail, special delivery mail, hand delivery, fax, or e-mail:

U.S. Mail
Texas Health and Human Services Commission
Attention: Provider Finance, Mail Code H-400
P.O. Box 149030
Austin, Texas 78714-9030

Overnight mail or special delivery mail
Texas Health and Human Services Commission
Attention: Provider Finance, Mail Code H-400
North Austin Complex
4601 W Guadalupe St.
Austin, Texas 78751

Phone number for package delivery: (512) 730-7401

Attention: Provider Finance at (512) 730-7475


Preferred Communication.  During the current state of disaster due to COVID-19, physical forms of communication are checked with less frequency than during normal business operations.  For quickest response, and to help curb the possible transmission of infection, please use e-mail or phone if possible, for communication with HHSC related to this rate hearing.

Persons with disabilities who wish to participate in the hearing and require auxiliary aids or services should call Provider Finance at (512) 730-7401 at least 72 hours before the hearing so appropriate arrangements can be made.