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Reimbursement Rate Updates for Certain HCPCS Procedure Codes Effective January 1, 2026, for Texas Medicaid

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Effective for dates of service on or after January 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will implement reimbursement rate updates for certain Healthcare Common Procedure Coding System (HCPCS) procedure codes for Texas Medicaid.

Providers can view the updates in the following spreadsheets:

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.