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Reimbursement Rate Updates for Certain Drug Procedure Codes Effective July 1, 2025

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TMHP has revised the reimbursement rates for the HCPCS drug procedure codes that are listed in the Drug Procedure Codes spreadsheet. The new rates are effective for all claims with dates of service on or after July 1, 2025.

TMHP will identify and reprocess any claims that have been affected by this update. Any adjustments to claims reimbursement amounts will appear on future R&S Reports.

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

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.