Reimbursement Rates for Some 2014 HCPCS Procedure Codes to Be Implemented for the CSHCN Services Program
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1 Reimbursement Rates for Some 2014 HCPCS Procedure Codes to Be Implemented for the CSHCN Services Program Information posted May 20, 2014 May 29, 2014, for dates of service on or after January 1, 2014, the Children with Special Health Care Needs (CSHCN) Services Program will implement initial reimbursement rates for some 2014 Healthcare Common Procedure Coding System (HCPCS) procedure codes. The tables on the following pages show the reimbursement rate changes that will be applied to affected procedure codes in the following categories: Ambulatory Surgical Centers Clinical Laboratory (TOS 5) Durable Medical Equipment (Prosthetics, Orthotics and Supplies) Non-Drugs (TOS) Non-Clinical Laboratory (TOS) Physician Administered Drugs Oncology Physician Administered Drugs Surgery Assistant Surgery Services Radiation Therapy (TOS 6, I, T) Claims for any of these procedure codes with dates of service on or after January 1, 2014, which were processed before the implementation date, will be reprocessed. Providers may receive additional payment, which will be reflected on Remittance and Status (R&S) Reports. For more information, call the TMHP-CSHCN Services Program Contact Center at
2 Ambulatory Surgical Centers (2014 Annual HCPCS) Service (TOS)* Procedure Code Age Range Group Number Max Fee F N/A $70.56 F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F N/A $31.86 F N/A $68.54 F N/A $41.71 F N/A $49.46 F N/A $44.44 F N/A $50.94 F F C TOS*: F = Ambulatory Surgical Centers
3 Service (TOS)* Procedure Code Age Group Clinical Lab Fee Clinical Laboratory 12.5% Adjusted Clinical Lab Fee Sole Community Hospital Fee 12.5% Adjusted Sole Community Fee $19.30 $16.21 $19.94 $ $25.23 $21.19 $26.07 $ $18.73 $15.73 $19.35 $ $18.09 $15.20 $18.69 $ $18.09 $15.20 $18.69 $ $18.09 $15.20 $18.69 $ $24.63 $20.69 $25.45 $ $18.09 $15.20 $18.69 $ $24.63 $20.69 $25.45 $ $18.09 $15.20 $18.69 $ $47.87 $40.21 $49.47 $41.55 TOS*: 5 = Laboratory
4 Durable Medical Equipment, Prosthetics, Orhotics and Supplies Service (TOS)* Procedure Code Age Range Fee Percent Reduction Adjusted Fee (Net of Reductions) 9 T $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ L $ % $ TOS*: 9 = Other Durable Medical Equipment (DME) Purchased Used
5 Non Drugs (TOS1) Service (TOS)* Procedure Code Age Range POS Fee Percent Reduction Reductions) N/F $ % $ N/F $ % $ $ % $ $ % $ N/F $ % $ N/F $ % $ $ % $ $ % $ N/F $ % $ N/F $ % $ $ % $ $ % $ N/F $ % $ N/F $ % $ $ % $ $ % $ TOS*: 1 = Medical
6 Service (TOS)* Procedure Code Age Range Non-Clinical Laboratory Fee Percent Reduction Adjusted Fee (Net of Reductions) $ % $ $ % $88.17 TOS*: 5 = Laboratory
7 Service (TOS)* Physcian Administered Drugs - Oncology Reductions) Procedure Code Age Range Fee Percent Reduction 1 J $ % $ J $ % $ J $2, % $2, TOS*: 1 = Medical
8 Physician Administered Drugs Service TOS* Reductions) Procedure Code Age Range Fee Percent Reduction $ % $ C $ % $ J $ % $ J $ % $ J $ % $ J $ % $ J $ % $ Q $ % $ Q $ % $ Q $ % $ Q $ % $ Q $ % $ Q $ % $ Q $ % $ Q $ % $ Q $ % $ Q $ % $ Q $ % $43.35 TOS*: 1 = Medical
9 Surgery and Assistant Surgery Place of Relative Service Procedure Service Age Value Unit Conversion Fee Percent Reductions) (TOS)* Code (POS)** Range (RVU) Factor Reduction N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $1, % $1,027.82
10 Surgery and Assistant Surgery Place of Relative Service Procedure Service Age Value Unit Conversion Fee Percent Reductions) (TOS)* Code (POS)** Range (RVU) Factor Reduction N/F $26.73 $ % $ N/F $28.07 $1, % $1, N/F $26.73 $1, % $1, N/F 0-20 $1, % $1, N/F $1, % $1, N/F 0-20 $1, % $1, N/F $1, % $1, N/F 0-20 $1, % $1, N/F $1, % $1, N/F 0-20 $2, % $2, N/F $2, % $2, N/F 0-20 $1, % $1, N/F $1, % $1, N/F 0-20 $1, % $1, N/F $1, % $1, N/F 0-20 $1, % $1, N/F $1, % $1, N/F 0-20 $2, % $2, N/F $2, % $2, N/F $28.07 $ % $ N/F $26.73 $ % $ N $28.07 $2, % $2, F $28.07 $ % $ N $26.73 $2, % $2, F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $3, % $3, F $28.07 $ % $ N $26.73 $3, % $3, F $26.73 $ % $ N $28.07 $1, % $1, F $28.07 $ % $ N $26.73 $1, % $1, F $26.73 $ % $ N $28.07 $3, % $3, F $28.07 $ % $ N $26.73 $3, % $3, F $26.73 $ % $ N $28.07 $6, % $6, F $28.07 $ % $ N $26.73 $5, % $5, F $26.73 $ % $ N $28.07 $7, % $7, F $28.07 $ % $ N $26.73 $7, % $7, F $26.73 $ % $ N $28.07 $5, % $5, F $28.07 $ % $ N $26.73 $5, % $5, N/F $26.73 $ % $ N/F $ $ % $ N/F $ $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $64.84
11 Surgery and Assistant Surgery Place of Relative Service Procedure Service Age Value Unit Conversion Fee Percent Reductions) (TOS)* Code (POS)** Range (RVU) Factor Reduction N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N $28.07 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $110.87
12 Surgery and Assistant Surgery Place of Relative Service Procedure Service Age Value Unit Conversion Fee Percent Reductions) (TOS)* Code (POS)** Range (RVU) Factor Reduction F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N $28.07 $ % $ F $28.07 $ % $ N $26.73 $ % $ F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ N/F $28.07 $ % $ N/F $26.73 $ % $ TOS*: 2 = Surgery, 8 = Assistant Surgery POS*: N = Non-Facility, F = Facility
13 Service (TOS)* Procedure Code Radiation Therapy Services, Professional Component and Technical Component Age Range Place of Service (POS)** Relative Value Unit (RVU) Conversion Factor Fee Percent Reduction Adjusted Fee (Net of Reductions) N/F $ $ % $ N/F $ $ % $ I N/F 2.9 $ $ % $81.39 I N/F 2.9 $ $ % $77.52 T N/F 9.17 $ $ % $ T N/F 9.17 $ $ % $ TOS*: 6 = Radiation Therapy, I = Professional Component, T = Technical Component POS**: N= Non-Facility, F = Facility
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