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First Quarter 2026 HCPCS Updates for the CSHCN Services Program

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On March 31, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the first quarter 2026 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2026. This article details the HCPCS updates.

First Quarter 2026 HCPCS Added Procedure Codes

All new benefits must go through the Texas Medicaid rate hearing process to allow public comment on proposed reimbursement rates. The Children with Special Health Care Needs (CSHCN) Services Program must review the adopted Texas Medicaid rates to determine whether they are fiscally feasible for the program.

Note: The CSHCN Services Program may adopt temporary or interim rates for procedure codes before the rate hearing process is complete. TMHP will deny any claims until they’ve implemented a rate or an interim rate for a procedure code. After the rate is implemented, TMHP may process any affected claims according to the Centers for Medicare & Medicaid Services (CMS) effective date.

After the rate hearing, the CSHCN Services Program must approve the expenditures before the rates can be adopted. TMHP will notify providers in a future article if a proposed reimbursement rate will change or if claims for a procedure code will not be reimbursed because the expenditures are not approved.

The CSHCN Services Program will add the following procedure codes as benefits pending the required Texas Medicaid rate hearing:

Procedure Codes
A6548C8007C8008C8009C8010C8011C8012C8013C9818G0681
G0682G0683G0684J0463J1164J8502L2221Q5162  

Note: Procedure codes C8007, C8008, C8009, C8011, C8012, and C8013 will be effective for dates of service on or after January 1, 2026. Procedure code C9818 will be effective for dates of service on or after January 23, 2026.

Effective April 1, 2026, the CSHCN Services Program will add the following procedure codes as noncovered procedure codes:

Procedure Codes
A2040A2041A2042A2043A2044A2045A4318A4479A8005A8006
A9294C1743C9309G0680J1098J1553J3404J9003J9183J9277
J9278J9601L5992M0233M0234Q0238Q4418Q4419Q4421Q4422
Q4423Q4424Q4425Q4426Q4427Q4428Q4429Q4435Q4436Q4437
Q4438Q4439Q4440Q5161      

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

Procedure Codes
A2040A2041A2042A2043A2044A2045Q4418Q4419Q4421Q4422
Q4423Q4424Q4425Q4426Q4427Q4428Q4429Q4435Q4436Q4437
Q4438Q4439Q4440       

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
C9818, J1164, J850218 years of age or older
Q516212 years of age or older

Procedure code A6548 will require prior authorization.

Procedure codes C8007 and C8011 will require prior authorization. Refer to the current CSHCN Services Program Provider Manual, “Neurostimulators and Neuromuscular Stimulators,” subsection 27.2.9, “Hypoglossal Nerve Stimulators (HNS),” for additional information.

Procedure code L2221 will require prior authorization. Refer to the current CSHCN Services Program Provider Manual, “Orthotic and Prosthetic Devices,” subsection 28.3.1, “Prior Authorization and Documentation Requirements,” for additional information.

First Quarter 2026 HCPCS Discontinued Procedure Codes

Effective April 1, 2026, CMS will discontinue the following procedure codes:

Procedure Codes
C9145C9307C9308L6000L6010L6020    

Claims for discontinued procedure codes will not be reimbursed after March 31, 2026.

First Quarter 2026 HCPCS Revised Procedure Codes

CMS will revise the descriptions of the following procedure codes:

Procedure CodesEffective Date
A2014October 1, 2022
A2037October 1, 2025
J0174July 6, 2023
L6028April 1, 2025

First Quarter 2026 HCPCS Informational Procedure Codes

The CSHCN Services Program will add the following procedure codes as informational only:

Procedure Codes
0614U0615U0616U0617U0618U0619U0620U0621U0622U0623U
0624U0625U0626U0627U0628U0629U0630U   

CMS will revise the descriptions of the following informational procedure codes:

Procedure CodesEffective Date
0256UOctober 1, 2021
0580UOctober 1, 2025

Updates for Procedure Codes From a Previous Quarter

The CSHCN Services Program will add the following procedure codes as benefits, pending a required rate hearing:

Procedure Codes
G0567J0681J7528       

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