In 2019, the Centers for Medicare & Medicaid Services (CMS) directed the Texas Health and Human Services Commission (HHSC) to update Texas Medicaid long-term services and supports (LTSS) billing codes to comply with the National Correct Coding Initiative (NCCI) by changing community-based LTSS billing in STAR Kids and STAR+PLUS from one hour to 15-minute billing units. This change required revisions to be made to both LTSS billing matrices.
The STAR+PLUS matrix contains billing information for STAR+PLUS and MMP. The STAR Kids matrix contains billing for STAR Kids and STAR Health. This notice contains important billing information for providers participating in these programs. 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 (published April 2022):
- STAR+PLUS and MMP providers must use Appendix XVI, Long Term Services and Supports Codes and Modifiers
- STAR Kids and STAR Health 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+PLUS and MMP providers must use Attachment Appendix XVI (Excel).
- STAR Kids and STAR Health providers must use Attachment: Appendix III (Excel).
Providers can find more information in the following Handbook Appendices:
- STAR+PLUS Handbook Revisions: https://hhs.texas.gov/handbooks/starplus-handbook/22-2-appendix-xvi-revised
- STAR Kids Handbook Revisions: https://hhs.texas.gov/handbooks/star-kids-handbook/22-1-appendix-iii-revised
For additional information, email firstname.lastname@example.org.