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Reimbursement Rate Updates for Certain Drug Procedure Codes Effective July 1, 2025

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The Texas Medicaid & Healthcare Partnership (TMHP) has revised the reimbursement rates for some Healthcare Common Procedure Coding System (HCPCS) drug procedure codes that were updated during the first quarter of 2025.

This change is effective for all claims with dates of service on or after July 1, 2025.

Providers can view the updates in the Drug Procedure Codes spreadsheet.

Claims Reprocessing

TMHP will identify and reprocess any claims that have been affected by this update. If there are any adjustments to claims reimbursement amounts, they 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.