November 9, 2022
What is New
Effective December 1, 2022, Texas Health and Human Services Commission (HHSC) will make updates to the STAR Kids Long-Term Services and Supports (LTSS) billing matrixes. This notification contains important billing information for providers participating in these programs.
Billing codes
All claims are required to be billed with a procedure code, modifier (if applicable), and the appropriate place of service code for the claim to be reimbursed correctly. LTSS services must be billed according to the STAR Kids LTSS Fee Schedules.
Prior Authorizations
All existing authorizations that have an end date on or after December 1, 2022, will automatically be updated to reflect the new procedure code and modifiers as listed below in the billing codes section. No action is needed by your organization for these existing authorizations. The authorizations were updated by October 17, 2022. The current authorization number will not change because the new procedure code and modifiers will be added on the same authorization number. Therefore, your agency will not receive a faxed authorization for this change. Refer to the crosswalk in the below billing codes section to see the new procedure code and modifiers.
Providers must bill using the new code and modifier combinations for services to be provided on or after December 1, 2022.
For prior authorizations and claims regarding services provided prior to December 1, 2022, providers must use the code and modifier combinations without the NCCI-related edits:
- STAR Kids providers must use Appendix III, LTSS Billing Matrix and Crosswalk.
For services that will be provided on or after December 1, 2022, providers must use the updated matrices posted on the Handbook Policy Updates web pages:
- STAR Kids providers must use Attachment: Appendix III (Excel) effective Dec.1,2022.
Electronic visit verification (EVV)
- Providers must ensure any EVV visits with date of service on or after December 1, 2022, reflect the new HCPCS code and modifiers according to the STAR Kids LTSS billing matrixes. Contact your EVV vendor if you need guidance or have issues with making updates to the authorization in the EVV system.
- Texas Medicaid & Healthcare Partnership will perform the EVV claim matching process on EVV claims that are submitted with the updated billing codes starting with dates of service beginning December 1, 2022, and ongoing against the EVV visit transactions.
- Before, submitting a claim, use the Accepted Visit Search tab in the EVV Portal to confirm that the visit transactions for the services billed have been accepted by the EVV Aggregator.
- BCBSTX recommends submitting claims with an individual date of service on each individual claim line item.
Resources
Providers can find more information in the following Handbook Appendices:
Questions
Providers, for questions or additional information, please:
- Contact your BCBSTX Medicaid Network team at 1-855-212-1615 or
- Submit via email to Texas Medicaid Network Department