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First Quarter NCCI Updates Effective January 1, 2026

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On January 25, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the first quarter National Correct Coding Initiative (NCCI) updates for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Providers can find the updated Medicaid NCCI rules, relationships, and general information on the Centers for Medicare & Medicaid Services (CMS) Medicaid NCCI web page. Providers should monitor the CMS website regularly for any updates to Medicaid NCCI rules and guidelines. Providers can also find a link to the CMS Medicaid NCCI web page on the Rate and Code Updates – NCCI Updates page of tmhp.com.

TMHP will reprocess any claims that it processes from January 1, 2026, through January 24, 2026, and that were affected by the CMS effective date of the NCCI third quarter changes. Payments might be decreased for NCCI code pairs or Medically Unlikely Edits (MUEs) that have been added, and payments might be increased for NCCI code pairs or MUEs that have been deleted.

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

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.