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Update to “Correction to ‘Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes Effective September 1, 2025’”

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This is an update to the article titled “Correction to ‘Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes Effective September 1, 2025,’” which was published on this website on August 13, 2025. The original article featured incorrect information in the “Cardiovascular Services, including Cardiography & Echocardiography - Rural Hospital” spreadsheet. The affected spreadsheet has been updated and now features the correct reimbursement information.

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 May 27, 2025.

The following topics were covered at the May 27, 2025, public rate hearing:

Claims Reprocessing

TMHP will identify and reprocess any claims that have been affected by this update. Any adjustments to claims reimbursement amounts will appear on future Remittance and Status (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.