Correction to the 2013 HCPCS Special Bulletin for ... - TMHP

Correction to the 2013 HCPCS Special Bulletin for Procedure
Code J1050
Information posted April 3, 2013
This is a correction to the 2013 Healthcare Common Procedure Coding System (HCPCS)
Special Bulletin. The bulletin has incorrect benefit information for added procedure code J1050.
The limitations for added procedure code J1050 stated that providers must bill the appropriate
quantity based on the amount used in milligrams (mg).
Effective for dates of service as indicated, the following is the complete, correct limitations for
procedure code J1050:
Program Effective Date Procedure Code Quantity Rate
Texas Medicaid (Title XIX)
Department of State
Health Services (DSHS)
Family Planning Program
Texas Women’s Health
Program (TWHP)
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January 1, 2013 J1050
(Medical
Indications)
January 1, 2013
through March
31, 2013
J1050/U1
(Contraception)
J1050/U1
(Contraception)
April 1, 2013 J1050/U1
(Contraception)
January 1, 2013 J1050/U1
(Contraception)
Amount
used in
mg
$0.19
1 $64.98
Amount
used in
mg
$0.46
1 $64.98
1 $64.98
Providers may refer to the current Texas Medicaid Provider Procedures Manual Gynecological
and Reproductive Health and Family Services Handbook, subsection 2.2 “Services, Benefits,
Limitations and Prior Authorization,” for more information.
Claims Reprocessing for Medicaid and TWHP
Procedure code J1050 was added during the 2013 HCPCS update. Claims that were submitted
before April 1, 2013, were denied but will be reprocessed. When these claims are reprocessed,
providers may receive additional payment, which will be reflected on Remittance and Status
(R&S) Reports.
TMHP will automatically reprocess affected claims. Providers are not required to appeal the
claims unless they have been denied for additional reasons after the claims reprocessing is
complete.
Reminder: Providers can refer to the article titled “Proposed Reimbursement Rates for Texas
Medicaid to Be Effective January 1, 2013, and April 1, 2013,” which was published on this
website February 28, 2013, for more information.
DSHS Family Planning Claims Reprocessing
Claims that were submitted with incorrect quantities can be appealed to TMHP with the correct
quantities.
Providers can refer to the article titled “Claims Reprocessing for DSHS Family Planning
Procedure Code J1050,” which was published on this website January 24, 2013, for more
information about claims that were submitted between January 1, 2013, and January 17, 2013.

For more information, call the TMHP Contact Center at 1-800-925-9126.
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