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Reimbursement Rate Updates for Procedure Codes Presented at the July 22, 2025, Public Rate Hearing

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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 September 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the reimbursement rate changes and updates for the procedure codes that were presented at the public rate hearing on July 22, 2025.

At the hearing, Legislative Review for the following services was covered:

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