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2026 TMPPM Release Notes

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The following tables show the section and handbooks that were changed in the Texas Medicaid Provider Procedures Manual. The changes are listed in reverse chronological order (newest first).

For changes that were made in 2025, see the 2025 Release Notes

February 2026 TMPPM Release Notes
HandbookRelated Articles and Notes
Volume 1: Section 3: TMHP Electronic Data Interchange (EDI)

Update to “TMHP EDI Onboarding and Testing Changes Effective December 31, 2025”

Information posted December 23, 2025

Volume 1: Section 4: Client Eligibility

Providers May Use Mother's Medicaid ID When Submitting Claims for Newborns

Information posted December 1, 2025

Children’s Services Handbook: Appendix B: Immunizations

HCPCS Annual Updates Effective January 1, 2026

Information posted December 31, 2025

Children’s Services Handbook: Appendix F: THSteps Quick Reference Guide

HCPCS Annual Updates Effective January 1, 2026

Information posted December 31, 2025

Children’s Services Handbook: Medical services (Sections 1-2 and 4-8)

HCPCS Annual Updates Effective January 1, 2026

Information posted December 31, 2025

Clinics and Other Outpatient Facility Services HandbookUpdated section reference in Section 1, General Information for "Carve Out Services" in the Medicaid Managed Care handbook.
Healthy Texas Women (HTW) Program Handbook

HCPCS Annual Updates Effective January 1, 2026

Information posted December 31, 2025

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

HCPCS Annual Updates Effective January 1, 2026

Information posted December 31, 2025

Medical Transportation Program Handbook

Update to “TMHP EDI Onboarding and Testing Changes Effective December 31, 2025”

Information posted December 23, 2025

Outpatient Drug Services Handbook

Removed duplicate letter at the beginning of the word axatilimab-csfr in subsection 6.16.1, "Prior Authorization Requirements."

Removed Emflaza HHS Form 1347 and Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors HHS Form 1355, and replaced the website link for the Clinical Prior Authorization Assistance Chart in section 13.1, "Clinical Prior Authorization." Removed text "on the PAXpress website" from the reference in section 13.3, "Obtaining Prior Authorization.

HCPCS Annual Updates Effective January 1, 2026

Information posted December 31, 2025

Benefit information in Section 6.6, "Ajovy (fremanezumab-vfrm)" was moved to Section 6.26, "Calcitonin Gene–Related Peptide (CGRP) agents," and the duplicate subsection 6.26.2, "Fremanezumab-vfrm (Ajovy)," was replaced.

Iron Injection Age Limitations to Be Updated for Texas Medicaid

Information posted January 2, 2026

Removed all benefit information for immune globulin in section 6.66, Immune Globulin.

Corrected diagnosis code in Section 6.59.1, “Darbepoetin Alfa” from D462 to D4621.

January 2026 TMPPM Release Notes
HandbookRelated Articles and Notes
Volume 1: Section 4: Client Eligibility

Providers May Use Mother's Medicaid ID When Submitting Claims for Newborns

Information posted December 1, 2025

Volume 1: Section 6: Claims Filing

Providers May Use Mother's Medicaid ID When Submitting Claims for Newborns

Information posted December 1, 2025

Updated claims filing deadline info for 2026.

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

TMPPM Update: Hospital Beds and Equipment

Information posted November 14, 2025

Medicaid Managed Care Handbook

Dual Demonstration MMP Program Ending on January 1, 2026

Information posted November 14, 2025

Outpatient Drug Services Handbook

Revised text in first sentence of section 6.42, "Elivaldogene Autotemcel (Skysona") from "ae" to "as is".)

Submitting Claims for HCCAD Skysona With U3 Modifier (Procedure Code J3590)

Information posted December 2, 2025

Changes to Hepatitis C Agents Drug Class Effective January 2026

Information posted November 26, 2025

Texas Medicaid Prior Authorization Update for Clofarabine Effective January 1, 2026

Information posted November 21, 2025

Removed all benefit information from section 6.73, "Interferon," from the Outpatient Drug Services handbook.

Removed duplicate text "lovotibeglogene autotemcel" in the fifth statement listed in section 6.114, "Sickle Cell Disease Gene Therapy."

Fixed indention at the beginning of some statements in the following sections: 10.3.1, "Background on Hepatitis C," 10.3.2, "HCV Screening and Testing," 10.3.3, "Treatment Coverage," 10.3.4, "Follow-Up After Treatment," 10.3.5, "Pregnant Clients," and 10.3.6, "Resources for Providers."

Replaced broken URL link for Synagis in the table of section 13.1, "Clinical Prior Authorization."

Replaced broken web page link for Prescriber Resources in section 10.3.6, "Resources for Providers."

Vision and Hearing Services HandbookUpdated payable provider type information for ear and throat examination procedure codes in section 2.2.3.7.4 to reflect current policy.