Texas Medicaid Implements First Quarter 2025 HCPCS Updates
The Texas Medicaid & Healthcare Partnership (TMHP) adopted the first quarter of 2025 Healthcare Common Procedure Coding System (HCPCS) updates starting with April 1, 2025 dates of service on March 27, 2025. The procedure code updates present new entries and noncovered codes as well as age restrictions and necessary prior authorizations and eliminated codes.
Newly Added Procedure Codes
TMHP added the CAD procedure codes C9302 and J0281 and J1072 and J1271 and J1299 and J1308 together with other new codes to their system. The procedures will receive coverage under Texas Medicaid starting April 1, 2025. The rates must be implemented before claims denial until the reprocessing of impacted claims will commence.
Through the HTW program J1271 became an added benefit to the available benefits.
| Clinician-Administered Drug (CAD) Procedure Codes | ||
| C9302 | C9303 | C9304 |
| J0281 | J1072 | J1271 |
| J1299 | J1308 | J1808 |
| J1938 | J2351 | J2804 |
| J2865 | J9024 | J9054 |
| Q2057 | Q5147 | |
Noncovered Procedure Codes
Texas Medicaid will cease coverage of C9300, J2428, J7521, A2030-A2035, E0201, E1032, G0566 and other codes as of April 1, 2025.
| CAD Procedure Codes | ||
| C9300 | C9301 | J2428 |
| J7521 | J9038 | J9161 |
| Q5148 | Q5149 | Q5150 |
| Q5151 | Q5152 | Q9999 |
| Non-CAD Procedure Codes | ||
| A2030 | A2031 | A2032 |
| A2033 | A2034 | A2035 |
| A6515* | A6516* | A6517* |
| A6518* | A6519* | A6611* |
| A9154 | A9611 | C8004 |
| C8005 | E0201 | E1022* |
| E1023 | E1032* | E1033* |
| E1034* | E1832* | G0183 |
| G0566 | G0567 | L0720* |
| L1933* | L1952* | L5827 |
| L6028* | L6029* | L6030* |
| L6031* | L6032* | L6033* |
| L6037* | L6700 | L7406 |
| Q4354 | Q4355 | Q4356 |
| Q4357 | Q4358 | Q4359 |
| Q4360 | Q4361 | Q4362 |
| Q4363 | Q4364 | Q4365 |
| Q4366 | Q4367 | S4024 |
The Texas Medicaid rate hearing process will be necessary to approve specific codes that have an asterisk (*) mark.
Additional Benefit Information
| Diagnosis Codes | ||
| C155 | C158 | C159 |
| C160 | C161 | C162 |
| C163 | C164 | C165 |
| C166 | C168 | C169 |
| Procedure Codes | ||
| L6028 | L6029 | L6030 |
| L6031 | L6032 | L6033 |
| L6037 | ||
Age Limitations and Prior Authorization Requirements
Procedure codes J9054 and C9304 and J2351 require age-based limitations for patients under 24 months and those above 18 years. The procedure codes E1022, L0720, L6028 and J1072 need authorization before scheduling the appointment.
First Quarter 2025 HCPCS Revised Procedure Codes
| Procedure Codes | ||
| 99232 | A4453 | |
| A6549 | A6583 | |
| A6586 | A6587 | |
| C1739 | C9793 | |
| E1028 | E1801 | |
| E1816 | E1818 | |
| J9073 | L1932 | |
| L1971 | L6692 | |
| S4020 | S4021 | |
First Quarter 2025 HCPCS Informational Procedure Codes
| Procedure Codes | ||
| 0531U | 0532U | 0533U |
| 0534U | 0535U | 0536U |
| 0537U | 0538U | 0539U |
| 0540U | 0541U | 0542U |
| 0543U | 0544U | 0545U |
| 0546U | 0547U | 0548U |
| 0549U | 0550U | 0551U |
Discontinued and Revised Codes
The procedure codes A9155, G0564 J1094, and S4988 will cease to exist starting March 31, 2025. The description of procedure codes 99232 A4453 and L1971 will experience changes.
Discontinued Procedure Codes
| Procedure Codes | ||
| A9155 | G0564 | G0565 |
| J1094 | J1300 | J1810 |
| J1890 | J1940 | J9037 |
| J9247 | L8010 | Q4231 |
| Q5139 | S0017 | S0028 |
| S0032 | S0039 | S4988 |
For full details, visit TMHP or call the TMHP Contact Center at 800-925-9126.
