Effective September 1, 2025, the Texas Health and Human Services Commission (HHSC) will implement updates to billing codes and modifiers for Long-Term Services and Supports (LTSS) delivered through the STAR+PLUS Home and Community-Based Services (HCBS) program. These changes are part of the transition to the Patient-Driven Payment Model (PDPM) for long-term care (LTC) and are designed to better align reimbursement with member needs and acuity levels.
This change aligns with updates issued by the Texas Health and Human Services Commission (HHSC) and is required by federal regulation (42 CFR §441.302(e) and (f)).
Community First Health Plans is updating its STAR+PLUS billing requirements to reflect this transition. These updates will affect how procedure codes and modifiers are used for long-term services and supports (LTSS).
What Providers Need to Know:
- New Billing Requirements: Providers must begin using updated procedure codes and modifiers when submitting prior authorizations and claims for STAR+PLUS LTSS services.
- Prior Authorizations: Existing authorizations may need to be adjusted to align with the new billing codes.
- Internal Processes: Providers should update internal billing systems and procedures to ensure compliance with the new requirements.
- Avoid Claim Issues: Following the updated procedures is essential to avoid claim denials or Electronic Visit Verification (EVV) rejections due to mismatched billing information.
Important Billing Reminder:
If a Provider submits a claim using incorrect codes for services provided on or after September 1, 2025, the claim may be denied due to the use of retired codes or modifiers. In such cases, the Provider must resubmit the claim using the appropriate codes from the updated billing matrix.
Providers can review the updated STAR+PLUS LTSS billing matrix and PDPM implementation materials here:
- HHSC Notice- Updates to the STAR PLUS LTSS Billing Matrices due to PDPM LTC Implementation (PDF)
- HHSC Notice – Upcoming Changes to STAR+PLUS LTSS Billing Codes and Modifiers:
HHSC Contact:
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter