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PILOT MEDICAID HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODE MODIFICATION REQUEST PROCESS Pilot Medicaid HCPCS Code Request Process The Pilot Medicaid Code Request Process provides State Medicaid agencies with a mechanism for requesting new Healthcare Common Procedure Coding System (HCPCS) codes or modifications to the existing HCPCS Code Set that is similar to the national HCPCS code request process, but which is designed specifically for Medicaid programs. This pilot process is the new procedure States should use to request modifications to the HCPCS Level II Code Set that are needed to satisfy national Medicaid program operating needs. Under this process, the State Medicaid agency must submit its request to the Center for Medicaid and State Operations (CMSO) using the Medicaid application format provided below. A subgroup of the internal CMS HCPCS Workgroup, consisting of CMSO program staff and State Medicaid agency representatives to the CMS HCPCS Workgroup, initially reviews the request. If clarification is needed, the requester will be contacted and provided the opportunity to make changes to its request, or to supply additional information. If a preliminary decision is made by the subgroup that a national Medicaid program operating need exists, the request will be submitted to the CMS HCPCS Workgroup for discussion at a regularly scheduled meeting. Requests for coding changes that do not represent a national Medicaid program operating need will not be forwarded to the Workgroup, and the requester will be notified by CMSO staff, and provided an explanation. State Medicaid agency requests for modifications to the existing HCPCS Level II Code Set should be submitted by following the procedures outlined at the Medicaid HCPCS websites identified in the related links below.
Page Last Modified: 06/03/2008 11:28:03 AM
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