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Fourth Quarter NCCI Updates Effective October 1, 2025

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On October 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will implement fourth quarter National Correct Coding Initiative (NCCI) updates for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Providers can find the updated Medicaid NCCI rules, relationships, and general information on the Centers for Medicare & Medicaid Services (CMS) Medicaid NCCI web page. A link to the CMS Medicaid NCCI web page is also available on the Rate and Code Updates – NCCI Updates web page on tmhp.com.

Providers should monitor the CMS website regularly for any updates to Medicaid NCCI rules and guidelines.

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

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.