Effective Sept. 1, 2021: Subcutaneous Internal Cardiac Defibrillator (S-ICD) to Become a Texas Medicaid Benefit
What is New?
On Sept. 1, 2021, Texas Medicaid and Healthcare Partnership (TMHP) 
will add subcutaneous internal cardiac defibrillator (S-ICD) as a Texas Medicaid benefit. This includes procedure codes 33270, 33271, 33273, 33274, 93287 and 93290.
Requirements for Billing:
Insertion or Replacement Services
- Code 33270 (Insertion or replacement)
- Code 33271 (insertion)
- Reimbursed to:
- Physician providers for services rendered in the inpatient and outpatient hospital setting
- Ambulatory surgical center providers for services rendered in the outpatient hospital setting
Removal Services
- Code 33272 (removal)
- Reimbursed to:
- Physician providers for services rendered in the inpatient and outpatient hospital setting
Repositioning Services
- Code 33273 (repositioning)
- Reimbursed to:
- Physician providers for services rendered in the inpatient and outpatient hospital setting
- Ambulatory surgical center providers for services rendered in the outpatient hospital setting
Peri-Procedural and Interrogation Device Evaluation Services
- Code 93287 and 93290 (peri-procedural and interrogation device evaluation)
- Reimbursement:
- The total component can be reimbursed to physician assistant (PA), nurse practitioner (NP), and clinical nurse specialist (CNS) providers for services rendered in the office, inpatient and outpatient settings.
- The professional component can be reimbursed to PA, NP, CNS, and physician providers for services rendered in the office, inpatient and outpatient settings
- The technical component can be reimbursed:
- To physician, PA, NP, CNS, portable X-ray supplier, radiological lab, and physiological lab providers for services rendered in the office setting.
- To hospital providers for services rendered in the outpatient hospital setting.
Questions:
Contact our BCBSTX Medicaid Provider Service Center at 1-877-560-8055 or contact your BCBSTX Medicaid Provider Network Representative at 1-855-212-1615.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
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