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Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes Effective April 1, 2025, and June 1, 2025

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after April 1, 2025, reimbursement rate changes and updates for the procedure codes that were presented at the public rate hearing on February 14, 2025, will be implemented.

The following topics were covered at the hearing:

Effective for Dates of Service on or After April 1, 2025

Effective for Dates of Service on or After June 1, 2025

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