Long-term Care Bill Code Crosswalks

Long-term Care Bill Code Crosswalk (Updated November 17, 2020)

The bill code crosswalk is a cross-referenced code set used to match the Texas Long-term Care (LTC) Local Codes (i.e., bill codes) to the National Standard Procedure Codes (e.g., procedure, item, revenue codes). You must use information on the bill code crosswalk (associated with the bill code which reflects the service billed) to claim payment for services. MS Excel Format

Texas Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Bill Code Crosswalk (Updated Dec. 1, 2015)

This crosswalk is to be used when HCS and TxHmL providers submit claims in CARE with Dates of Service (DOS) through 7-31-2021. MS Excel Format | PDF Format

HCS and TxHmL Bill Code Crosswalk (Updated May 10, 2021)

This crosswalk is to be used when HCS and TxHmL providers submit claims in TMHP TexMedConnect or Electronic Data Interface (EDI) with DOS beginning 08-01-2021. MS Excel Format

Please note: This bill code crosswalk will be effective August 1, 2021 and will be used by TMHP Claims Management System for DOS August 1, 2021 and later. You must submit the Healthcare Common Procedure Coding System (HCPCS) and modifier combinations associated with the bill code on the bill code crosswalk, which reflects the service billed, to claim Medicaid payment for services.

All HCS/TxHmL Adaptive Aids, Dental and Minor Home Modification bill codes, previously submitted manually on form 4116s, are also included in this crosswalk to allow for automation of these claims. More information and instructions will be provided at a later date.

EVV-relevant services crosswalk of Long-Term Care, Acute Care, and Managed Care programs can be found in the Service Bill Codes section on the EVV website.

Program providers must use the appropriate HCPCS and modifier combinations in the EVV Services table to prevent EVV visit transaction rejections and EVV claim match denials.