Proposed Medicaid Payment Rates for the Healthcare Common Procedure Coding System (HCPCS) Updates

February 3, 2023 - 9:00 am

United States

Update. Due to potentially hazardous weather conditions, this hearing will be conducted remotely with no physical entry permitted.

Hearing.  The Texas Health and Human Services Commission (HHSC) will conduct a public hearing to receive public comments on proposed Medicaid payment rates for the Healthcare Common Procedure Coding System (HCPCS) Updates.

To join the hearing from your computer, tablet, or smartphone, register for the hearing in advance using the following link:

Registration URL:
https://attendee.gotowebinar.com/register/6230594173097043807
Webinar ID: 771-673-795

After registering, you will receive a confirmation email containing information about joining the hearing. You can also dial in using your phone by calling:

Conference Number: (562) 247-8321
Phone Audio Passcode: 411-329-941
Audio PIN: (Please note, in order to receive a PIN to speak, registration is required.)

If you are new to GoToWebinar, please download the GoToMeeting app at https://global.gotomeeting.com/install/626873213 before the hearing starts.

A recording of the hearing will be archived and can be accessed on demand at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings under the “Archived” tab. The hearing will be held in compliance with Texas Human Resources Code Section 32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.

Proposal.  The proposed payment rates for the HCPCS Updates will be effective January 1, 2023 for the following topics:

Proposed to be effective December 8, 2022:

HCPCS Updates

COVID-19 Vaccine Administration Codes.

Proposed to be effective January 1, 2023:

Annual HCPCS Updates

Physician Administered Drugs - TOS 1 (Medical Service);

Non-Drugs – TOS 1 (Medical Service);

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

Radiological Services – TOS 4 (Radiology), TOS I (Professional Component), and TOS T (Technical Component);

Radiological Services - TOS 4 – Hospitals (CT 023);

Clinical Diagnostic Laboratory Services – TOS 5 (Laboratory);

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies - TOS 9 (Other Medical Items or Services), TOS J (DME Purchase-New), and TOS L (DME Rental–Monthly); and

Ambulatory Surgical Center - TOS F (Ambulatory Surgical Center and Hospital-based Ambulatory Surgical Center).

Proposed to be effective April 1, 2023:

Calendar Fee Review

Long-Acting Reversible Contraceptives (LARCS);

Medical Policy Review

Vendor Drug Program (VDP) Drug Clean Up;

Quarterly HCPCS Updates

Clinical Labs – TOS 5 (Clinical Labs); and

Durable Medical Equipment Rental – TOS L (Durable Medical Equipment Rental).

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

Section 355.8023, Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS);

Section 355.8061, Outpatient Hospital Reimbursement;

Section 355.8085, Reimbursement Methodology for Physicians and Other Practitioners;

Section 355.8121, Reimbursement for Ambulatory Surgical Centers;

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 355.8581, Reimbursement Methodology for Family Planning Services;

Section 355.8610, Reimbursement for Clinical Laboratory Services; and

Section 355.8641, Reimbursement Methodology for the Women's Health Program.

Rate Hearing Packet. A briefing packet describing the proposed payment rates will be made available at https://pfd.hhs.texas.gov/rate-packets on or after January 24, 2023. 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 PFDAcuteCare@hhs.texas.gov.

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

Fax
Attention: Provider Finance at (512) 730-7475

E-mail
PFDAcuteCare@hhs.texas.gov

Preferred Communication.  For quickest response 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.