Texas Medicaid: Changes made to STAR+PLUS billing codes and modifiers
AI Summary
Texas Medicaid STAR+PLUS is transitioning from RUG-III to PDPM payment methodology starting September 1, 2025. Long-term care providers must use new HCPCS codes T2031 for assisted living services and S5151 for respite care services when each member's Individual Service Plan (ISP) renews, or claims will be denied.
Action Required
Immediately: Billing team must monitor when each STAR+PLUS member's ISP renews and switch to new HCPCS codes T2031 (assisted living) and S5151 (respite care) with appropriate modifiers from the state's Payment Rate Information site. Train billing staff on the new LTSS billing matrix and review the STAR+PLUS Codes and Modifiers Guide sections for services on or after Sept. 1, 2025. Claims submitted with old RUG-III codes will be denied and require corrected claims.
Affected Billing Codes
Plan Types
Medicaid
States
TX
Specialties
geriatrics