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Quarterly Reimbursement Rate Updates for Some HCPCS Drug Procedure Codes Effective April 1, 2025

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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.

Effective for dates of service on or after April 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will change the reimbursement rates for some Healthcare Common Procedure Coding System (HCPCS) drug procedure codes that were updated during the first quarter of 2025.

TMHP will identify and reprocess any affected claims. Providers do not need to appeal these claims unless TMHP denies them for additional reasons after reprocessing is completed.

To view the updates, access the Drug Procedure Codes spreadsheet.

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