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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
-----------------------
AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept".

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONTINUED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NO AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does no t directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with TMHP or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of the Agreement. The ADA is a third party beneficiary to this Agreement.

5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must exit from this computer screen.

HCPCS Annual Updates Effective January 1, 2026

Last updated on 12/31/2025

On January 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will apply the 2026 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations. The updates will be effective for dates of service on or after January 1, 2026.

Note: Benefit changes related to the 2026 annual HCPCS updates will be published in a special bulletin by February 1, 2026.

Discontinued procedure codes will no longer be benefits of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program.

The presence of “Requires rate hearing” or “Requires rate review” in the 2026 HCPCS Procedure Code Additions table indicates a new procedure code that is pending a rate hearing and approval of expenditures. Providers will be notified in a future article if a new procedure code is not approved for reimbursement.

Providers may refer to the following resources for more information about the public rate hearings and approval of expenditures:

Important: To avoid submitting fraudulent claims, providers must submit claims with the procedure codes that are most appropriate for the services that are provided.

2026 HCPCS Procedure Code Additions

The table below lists the new HCPCS procedure codes:

Type of Service	Procedure Code	Medicaid Allowable	CSHCN Allowable	Healthy Texas Women (HTW) Allowable	HTW+ Allowable	Authorization Requirement
2	27458	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
8	27458	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	27458	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	27713	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
8	27713	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	27713	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	33882	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
8	33882	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	35602	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
8	35602	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37254	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37254	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37255	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37256	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37256	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37257	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37258	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37258	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37259	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37260	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37260	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37261	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37262	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37263	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37263	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37264	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37265	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37265	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37266	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37267	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37267	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37268	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37269	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37269	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37270	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37271	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37271	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37272	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37273	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37273	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37274	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37275	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37275	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37276	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37277	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37277	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37278	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37279	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37280	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37280	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37281	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37282	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37282	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37283	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37284	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37284	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37285	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37286	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37286	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37287	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37288	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37288	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37289	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37290	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37290	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37291	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37292	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37292	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37293	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37294	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37294	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37295	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37296	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37296	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37297	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37298	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	37298	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	37299	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	43889	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	43889	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	47384	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	47384	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	52443	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	52443	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	52597	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	52597	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55707	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	55707	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55708	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	55708	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55709	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	55709	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55710	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	55710	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55711	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	55711	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55712	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	55712	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55713	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	55713	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55714	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	55714	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55715	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	55868	Not a benefit	Not a benefit	Not a benefit	Not a benefit
8	55868	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	55868	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	55869	Not a benefit	Not a benefit	Not a benefit	Not a benefit
8	55869	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	55869	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	55877	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	55877	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	62330	Not a benefit	Not a benefit	Not a benefit	Not a benefit
8	62330	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	62330	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	62331	Not a benefit	Not a benefit	Not a benefit	Not a benefit
8	62331	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	63032	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
8	63032	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	64567	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	64567	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	64654	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	64654	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	64655	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	64655	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	64656	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	64656	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	64657	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	64657	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	64658	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	64658	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	64659	Not a benefit	Not a benefit	Not a benefit	Not a benefit
F	64659	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	64728	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	64728	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
4	70471	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
I	70471	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
T	70471	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
4	70472	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
I	70472	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
T	70472	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
4	70473	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
I	70473	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
T	70473	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
4	75577	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
I	75577	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
T	75577	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
6	77436	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
I	77436	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
T	77436	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
6	77437	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
6	77438	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
6	77439	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
I	77439	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
5	81354	Not a benefit	Not a benefit	Not a benefit	Not a benefit
5	81524	Not a benefit	Not a benefit	Not a benefit	Not a benefit
5	87182	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
5	87183	Not a benefit	Not a benefit	Not a benefit	Not a benefit
5	87494	Requires rate hearing	Requires rate review	Requires rate hearing	Requires rate hearing
5	87627	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
5	87812	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	90481	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	90482	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	90483	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	90484	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	90631	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	91124	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	91125	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92288	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	92628	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92629	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92631	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92632	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92634	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92635	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92636	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92637	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92638	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92639	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92641	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	92642	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	92930	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	92930	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
2	92945	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
F	92945	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	93145	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	93146	Not a benefit	Not a benefit	Not a benefit	Not a benefit
9	97007	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	97008	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	97009	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	98979	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	98984	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	98985	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	98986	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	99445	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	99470	Not a benefit	Not a benefit	Not a benefit	Not a benefit
9	A4295	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
9	A4296	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
9	A4297	Informational only	Informational only	Not a benefit	Not a benefit
J	C1607	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
9	C1608	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	C7566	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	C7567	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	C7568	Informational only	Informational only	Not a benefit	Not a benefit
2	C7569	Informational only	Informational only	Not a benefit	Not a benefit
2	C7570	Informational only	Informational only	Not a benefit	Not a benefit
2	C7571	Informational only	Informational only	Not a benefit	Not a benefit
9	C9176	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	C9307	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
1	C9308	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
9	C9810	Not a benefit	Not a benefit	Not a benefit	Not a benefit
9	C9811	Not a benefit	Not a benefit	Not a benefit	Not a benefit
9	C9812	Not a benefit	Not a benefit	Not a benefit	Not a benefit
9	C9813	Not a benefit	Not a benefit	Not a benefit	Not a benefit
9	C9814	Not a benefit	Not a benefit	Not a benefit	Not a benefit
9	C9815	Not a benefit	Not a benefit	Not a benefit	Not a benefit
9	C9816	Not a benefit	Not a benefit	Not a benefit	Not a benefit
9	C9817	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D0426	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D0461	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D1720	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5877	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5878	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5909	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5930	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5938	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5939	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5940	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5941	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5942	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5943	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5944	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5945	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5946	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5947	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5948	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D5949	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D6049	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
W	D6196	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D6280	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D9128	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D9129	Not a benefit	Not a benefit	Not a benefit	Not a benefit
W	D9224	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
W	D9225	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
W	D9244	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
W	D9245	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
W	D9246	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
W	D9247	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
W	D9936	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0568	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0569	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0570	Not a benefit	Not a benefit	Not a benefit	Not a benefit
2	G0571	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0660	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0661	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0662	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0663	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0664	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0665	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0666	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0667	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G0668	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	G9871	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	J0013	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit	Medicaid
1	J0162	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	J0654	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	J1073	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit	Medicaid
1	J1736	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	J1737	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	J1837	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	J2516	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	J2596	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	J2711	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	J3291	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	J3376	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	J3379	Requires rate hearing	Requires rate review	Not a benefit	Not a benefit
1	J3387	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit	Medicaid
1	J3389	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	J7299	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	J7528	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	J9184	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
1	J9256	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
1	J9282	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
1	J9326	Requires rate hearing	Not a benefit	Not a benefit	Not a benefit
1	M1426	Informational only	Informational only	Not a benefit	Not a benefit
1	M1427	Informational only	Informational only	Not a benefit	Not a benefit
1	M1428	Informational only	Informational only	Not a benefit	Not a benefit
1	M1429	Informational only	Informational only	Not a benefit	Not a benefit
1	M1430	Informational only	Informational only	Not a benefit	Not a benefit
1	M1431	Informational only	Informational only	Not a benefit	Not a benefit
1	M1432	Informational only	Informational only	Not a benefit	Not a benefit
1	M1433	Informational only	Informational only	Not a benefit	Not a benefit
1	M1434	Informational only	Informational only	Not a benefit	Not a benefit
1	M1435	Informational only	Informational only	Not a benefit	Not a benefit
1	M1436	Informational only	Informational only	Not a benefit	Not a benefit
1	M1437	Informational only	Informational only	Not a benefit	Not a benefit
1	M1438	Informational only	Informational only	Not a benefit	Not a benefit
1	M1439	Informational only	Informational only	Not a benefit	Not a benefit
1	M1440	Informational only	Informational only	Not a benefit	Not a benefit
1	M1441	Informational only	Informational only	Not a benefit	Not a benefit
1	M1442	Informational only	Informational only	Not a benefit	Not a benefit
1	M1443	Informational only	Informational only	Not a benefit	Not a benefit
1	M1444	Informational only	Informational only	Not a benefit	Not a benefit
1	M1445	Informational only	Informational only	Not a benefit	Not a benefit
1	M1446	Informational only	Informational only	Not a benefit	Not a benefit
1	M1447	Informational only	Informational only	Not a benefit	Not a benefit
1	M1448	Informational only	Informational only	Not a benefit	Not a benefit
1	M1449	Informational only	Informational only	Not a benefit	Not a benefit
1	M1450	Informational only	Informational only	Not a benefit	Not a benefit
1	M1451	Informational only	Informational only	Not a benefit	Not a benefit
1	M1452	Informational only	Informational only	Not a benefit	Not a benefit
1	M1453	Informational only	Informational only	Not a benefit	Not a benefit
1	M1454	Informational only	Informational only	Not a benefit	Not a benefit
1	M1455	Informational only	Informational only	Not a benefit	Not a benefit
1	M1456	Informational only	Informational only	Not a benefit	Not a benefit
1	M1457	Informational only	Informational only	Not a benefit	Not a benefit
1	M1458	Informational only	Informational only	Not a benefit	Not a benefit
1	M1459	Informational only	Informational only	Not a benefit	Not a benefit
1	M1460	Informational only	Informational only	Not a benefit	Not a benefit
1	M1461	Informational only	Informational only	Not a benefit	Not a benefit
1	M1462	Informational only	Informational only	Not a benefit	Not a benefit
1	M1463	Informational only	Informational only	Not a benefit	Not a benefit
1	M1464	Informational only	Informational only	Not a benefit	Not a benefit
1	M1465	Informational only	Informational only	Not a benefit	Not a benefit
1	M1466	Informational only	Informational only	Not a benefit	Not a benefit
1	M1467	Informational only	Informational only	Not a benefit	Not a benefit
1	M1468	Informational only	Informational only	Not a benefit	Not a benefit
1	M1469	Informational only	Informational only	Not a benefit	Not a benefit
1	M1470	Informational only	Informational only	Not a benefit	Not a benefit
1	M1471	Informational only	Informational only	Not a benefit	Not a benefit
1	M1472	Informational only	Informational only	Not a benefit	Not a benefit
1	M1473	Informational only	Informational only	Not a benefit	Not a benefit
1	M1474	Informational only	Informational only	Not a benefit	Not a benefit
1	M1475	Informational only	Informational only	Not a benefit	Not a benefit
1	M1476	Informational only	Informational only	Not a benefit	Not a benefit
1	M1477	Informational only	Informational only	Not a benefit	Not a benefit
1	M1478	Informational only	Informational only	Not a benefit	Not a benefit
1	M1479	Informational only	Informational only	Not a benefit	Not a benefit
1	M1480	Informational only	Informational only	Not a benefit	Not a benefit
1	M1481	Informational only	Informational only	Not a benefit	Not a benefit
1	M1482	Informational only	Informational only	Not a benefit	Not a benefit
1	M1483	Informational only	Informational only	Not a benefit	Not a benefit
1	M1484	Informational only	Informational only	Not a benefit	Not a benefit
1	M1485	Informational only	Informational only	Not a benefit	Not a benefit
1	M1486	Informational only	Informational only	Not a benefit	Not a benefit
1	M1487	Informational only	Informational only	Not a benefit	Not a benefit
1	M1488	Informational only	Informational only	Not a benefit	Not a benefit
1	M1489	Informational only	Informational only	Not a benefit	Not a benefit
1	M1490	Informational only	Informational only	Not a benefit	Not a benefit
1	M1491	Informational only	Informational only	Not a benefit	Not a benefit
1	M1492	Informational only	Informational only	Not a benefit	Not a benefit
1	M1493	Informational only	Informational only	Not a benefit	Not a benefit
1	M1494	Informational only	Informational only	Not a benefit	Not a benefit
1	M1495	Informational only	Informational only	Not a benefit	Not a benefit
1	M1496	Informational only	Informational only	Not a benefit	Not a benefit
1	M1497	Informational only	Informational only	Not a benefit	Not a benefit
1	M1498	Informational only	Informational only	Not a benefit	Not a benefit
1	M1499	Informational only	Informational only	Not a benefit	Not a benefit
1	M1500	Informational only	Informational only	Not a benefit	Not a benefit
1	M1501	Informational only	Informational only	Not a benefit	Not a benefit
1	M1502	Informational only	Informational only	Not a benefit	Not a benefit
1	M1503	Informational only	Informational only	Not a benefit	Not a benefit
1	Q4398	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4399	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4400	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4401	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4402	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4403	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4404	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4405	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4406	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4407	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4408	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4409	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4410	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4411	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4412	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4413	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4414	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4415	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4416	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4417	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4420	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4431	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4432	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q4433	Not a benefit	Not a benefit	Not a benefit	Not a benefit
1	Q5160	Not a benefit	Not a benefit	Not a benefit	Not a benefit

Note: The Family Planning Program has made no benefit changes as a result of the 2026 HCPCS updates.

The following procedure codes are Medicaid-only benefits and are not covered by Medicare:

Procedure Codes
92628	92629	92631	92632	92634	92635	92636	92637	92638	92639
92641	J0013	J3291

The following procedure codes are not benefits because they are considered part of another service:

Procedure Codes
Q4398	Q4399	Q4400	Q4401	Q4402	Q4403	Q4404	Q4405	Q4406	Q4407
Q4408	Q4409	Q4410	Q4411	Q4412	Q4413	Q4414	Q4415	Q4416	Q4417
Q4420	Q4431	Q4432	Q4433	C9812	C9813	C9814	C9815	C9816	D0461

Informational Reporting Procedure Codes

The following new procedure codes are used for reporting purposes and are informational only:

Medical Procedure Codes
0990T	0992T	0993T	0994T	0995T	0997T	0998T	1002T	1004T	1005T
1006T	1007T	1008T	1009T	1010T	1011T	1016T	1017T	1018T	1020T
1021T	1022T	1023T	1024T

Surgical Procedure Codes
0988T	0989T	0991T	0996T	0999T	1000T	1001T	1003T	1012T	1013T
1014T	1015T	1019T

Radiological Procedure Code
1025T

Laboratory Procedure Codes
0600U	0601U	0602U	0603U	0604U	0605U	0606U	0607U	0608U	0609U
0610U	0611U	0612U	0613U

Authorization or Prior Authorization

The Authorization Requirement column of the 2026 HCPCS Procedure Code Additions table indicates whether the procedure codes require authorization or prior authorization.

For procedure codes that require authorization or prior authorization but are awaiting a rate hearing and approval of expenditures, providers must follow the established authorization or prior authorization processes as defined in the following:

Current Texas Medicaid Provider Procedures Manual (TMPPM)
Current CSHCN Services Program Provider Manual
Articles published on the TMHP website at com

Important: For managed care clients, providers must contact the client’s Texas Medicaid managed care organization (MCO) for direction concerning prior authorization requests.

For services that require prior authorization or authorization, providers must obtain a timely authorization or prior authorization for the services that they provide. Providers must not wait until the rate hearing process is complete to request authorization or prior authorization. In this situation, TMHP does not grant retroactive prior authorization requests; the requests are denied as late submissions.

Providers must also meet the initial 95-day claims filing deadline and ensure that the authorization or prior authorization number is on the claim the first time that they submit it to TMHP for consideration of reimbursement. TMHP will deny claims that providers submit without the proper authorization.

Important: Authorization or prior authorization is a condition for reimbursement; it is not a guarantee of payment.

2026 HCPCS Discontinued Procedure Codes

Texas Medicaid and the CSHCN Services Program will not reimburse claims for the following list of discontinued 2026 HCPCS procedure codes after December 31, 2025:

Procedure Codes
27445	27468	33884	33889	33891	37220	37221	37222	37223	37224
37225	37226	37227	37228	37229	37230	37231	37232	37233	37234
37235	37500	52647	55700	75842	75956	75957	75958	75959	77014
77385	77386	77401	91120	91122	92590	92591	92592	92593	92594
92595	92921	92925	92929	92934	92938	92944	92975	92977	94662
C5271	C5272	C5273	C5274	C5275	C5276	C5277	C5278	C9089	C9305
C9306	C9751	C9784	D1352	D1705	D1706	D1707	D1712	D9248	G0071
G0511	G0512	G6001	G6002	G6003	G6004	G6005	G6006	G6007	G6008
G6009	G6010	G6011	G6012	G6013	G6014	G6015	G6016	G6017	G9604
J0172	J0190	J0200	J0205	J0215	J0288	J0350	J0365	J0380	J0395
J0710	J0715	J0795	J0889	J1267	J1330	J1443	J1444	J1445	J1452
J1457	J1562	J1620	J1655	J1710	J1945	J2504	J2513	J2910	J2940
J2995	J3280	J3305	J3310	J3320	J3355	J3364	J3365	J3400	J7309
J7310	J7505	J7513	J8562	J8650	J9019	J9020	J9098	J9151	J9165
J9212	J9270	Q0174	Q2017	Q4100	Q4106	Q5109	Q9969	S0013	S0080
S0189

The following informational reporting procedure codes have been discontinued:

Procedure Codes
0033U	0042T	0131U	0132U	0135U	0240U	0241U	0266T	0267T	0268T
0269T	0270T	0271T	0272T	0273T	0275T	0346U	0361U	0369U	0370U
0373U	0374U	0380U	0394T	0421T	0428U	0448U	0450U	0451U	0456U
0508U	0509U	0544U	0550U	0551U	0619T	0623T	0624T	0625T	0626T
0631T	0662T	0663T	0720T

2026 HCPCS Replacement Procedure Codes

Effective for dates of service on or after January 1, 2026, Texas Medicaid and the CSHCN Services Program will replace the following discontinued procedure codes with the corresponding replacement procedure codes:

Type of Service	Discontinued Codes	Replacement Codes	Medicaid Rate	CSHCN Rate
1	91120	91124	Requires rate hearing	Requires rate review
1	91122	91125	Requires rate hearing	Requires rate review
1	S0013	J0013	Requires rate hearing	Not a benefit
1	S0080	J2516	Requires rate hearing	Requires rate review
1	C9305	J9256	Requires rate hearing	Not a benefit
1	C9306	J9326	Requires rate hearing	Not a benefit

Prior Authorization Updates

Providers that have received prior authorization for the following discontinued 2026 HCPCS procedure code for dates of service that occur on or after or encompass January 1, 2026, do not have to update prior authorization requests that TMHP approved on or before December 31, 2025. TMHP will automatically update affected prior authorization requests with the corresponding new procedure code that replaces the discontinued procedure code as follows:

Type of Service	Discontinued Procedure Code	Direct Replacement Procedure Code
1	S0013	J0013

Providers that have received prior authorization for any of the following discontinued 2026 HCPCS procedure codes for dates of service that occur on or after or encompass January 1, 2026, must contact the TMHP Prior Authorization department to update the procedure codes that are prior authorized for those services:

Type of Service	Discontinued Procedure Codes	Prior Authorization Requirements
1	G0511	Medicaid
1	S0189	Medicaid

Procedure Code Description Changes

To identify procedure code description changes that are effective for dates of service on or after January 1, 2026, providers may refer to the HCPCS Quarterly Update web page on the Centers for Medicare and Medicaid Services (CMS) website.

Providers must contact the appropriate copyright holder to obtain procedure code descriptions.

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

Updates for Procedure Codes From a Previous Quarter

The following procedure codes will be added as benefits, pending a required rate hearing:

Procedure Codes	For Programs
91323	Texas Medicaid, HTW, CSHCN
C1742	Texas Medicaid, CSHCN
J0462	Texas Medicaid, CSHCN
J9361	Texas Medicaid
Q5098	Texas Medicaid, CSHCN
Q5156	Texas Medicaid, CSHCN
Q5157	Texas Medicaid, CSHCN
Q5158	Texas Medicaid, CSHCN

Note: Texas Medicaid 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.