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Reimbursement Rate Updates for Certain 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 implement reimbursement rate updates for certain first quarter 2025 Healthcare Common Procedure Coding System (HCPCS) drug procedure codes for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

TMHP will reprocess any affected claims that are identified. After the reprocessing is complete, providers will not need to appeal the claims unless TMHP has denied them for additional reasons.

To view the updates, access the following spreadsheets:

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