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HCPCS and CPT Code Prior authorization Update
Date: February 26, 2024
Attention: All Providers
Effective date: January 1, 2024
Call to action: The purpose of this communication is to offer information about the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) prior authorization updates.
How this impacts providers: Effective January 1, 2024 Texas Children’s Health Plan’s (TCHP's) prior authorization updates are listed below. These changes follow guidance from Texas Medicaid and Healthcare Partnership (TMHP). Medical necessity criteria for utilization review will be in accordance with Texas Medicaid Provider Procedure Manual (TMPPM).
The following CPT codes REQUIRE prior authorization effective 1.1.2024:
- J1304 (Toferson, inj, 1mg)
- E0733 (Transcutaneous Nerve Stim-Trigeminal)
- L5926 (Prosthesis-above knee)
The following CPT codes DO NOT REQUIRE prior authorization effective 1.1.2024:
- 75590 (MRI-coronary FFR)
- 27278 (Arthrodesis, sacroiliac joint)
- L3161 (foot adductus positioning device, adjustable)
Next step for Providers: Providers should follow the prior authorization guidelines as stated above and share this communication with their staff.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.