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Follow-Up to “HCPCS Annual Update Coming January 2026”

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This is a follow-up to the article titled “HCPCS Annual Update Coming January 2026,” which was published on this website on November 14, 2025.

The 2026 annual Healthcare Common Procedure Coding System (HCPCS) updates will be effective for dates of service on or after January 1, 2026, and will be presented at a rate hearing in March 2026. A hearing will still occur in February 2026 to propose pricing for long-acting reversible contraceptives (LARCS) and other services. Hearing dates will be posted on the Texas Health and Human Services Commission (HHSC) Meetings and Events website and published in the Texas Register.

Note: Texas Medicaid must approve expenditures before rates can be adopted. New benefits that are adopted by Texas Medicaid must undergo the rate hearing process to receive public comment on proposed reimbursement rates. For new benefits, an interim rate is typically set before the hearing to allow for claims processing.

The Texas Medicaid & Healthcare Partnership (TMHP) will publish the 2026 annual HCPCS information on tmhp.com as follows:

  • A website article will be published on December 31, 2025, identifying the new and discontinued 2026 annual HCPCS procedure codes.
  • A special bulletin will be published by February 1, 2026, with all benefit information that is related to the 2026 annual HCPCS updates.

Claims Submission for New Procedure Codes

Providers may submit claims for the new 2026 HCPCS procedure codes beginning January 1, 2026. These claims must be submitted within the initial 95-day filing deadline. Services that are provided before expenditures are approved will be denied with explanation of benefits (EOB) 02008, “This procedure code has been approved as a benefit pending the approval of expenditures. Providers will be notified of the effective dates of service in a future notification if expenditures are approved.”

Note: If expenditures are not approved for a particular procedure code, that procedure code will not be made a benefit effective January 1, 2026.

After Texas Medicaid approves expenditures, TMHP will identify and reprocess any claims that have been affected. Providers do not need to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete. If there are any adjustments to claims reimbursement amounts, they will appear on future Remittance and Status (R&S) Reports.

If the effective date changes for a new procedure code, TMHP will notify providers in a future article. Clients cannot be billed for services that are provided outside of the procedure code effective date.

Important: To avoid submitting fraudulent claims, providers must submit claims with the procedure codes that are most appropriate for the services that are provided.

Claims Submission for Discontinued Procedure Codes

Texas Medicaid and the Children with Special Healthcare Needs (CSHCN) Services Program will not reimburse claims for discontinued 2026 HCPCS procedure codes after December 31, 2025.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.