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First Quarter 2026 HCPCS Updates for Texas Medicaid

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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

Clinician-Administered Drug (CAD) Procedure Codes
C9818J0463J1164J3404J8502J9183J9277J9278J9601Q5162

Note: Procedure code C9818 will be effective for dates of service on or after January 23, 2026.

Texas Medicaid will add the CAD procedure codes listed in the table above as benefits as of the Centers for Medicare & Medicaid Services (CMS) effective date, April 1, 2026. TMHP will deny claims until a rate is implemented, but affected claims will be reprocessed back to the CMS effective date. Procedure codes will be reimbursable at the rate that is effective on April 1, 2026, until the Texas Health and Human Services Commission (HHSC) conducts a rate hearing, as required by Texas Administrative Code §355.201.

Providers may refer to the HHSC Provider Finance website for details related to rate hearings.

Non-CAD Procedure Codes
C8007C8008C8009C8010C8011C8012C8013G0681G0682G0683
G0684L2221        

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

Texas Medicaid will add the non-CAD procedure codes listed in the table above as benefits pending a required rate hearing.

All new benefits must go through the Texas Medicaid rate hearing process to allow for public comment on proposed reimbursement rates.

After the rate hearing, Texas Medicaid 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.

Effective April 1, 2026, Texas Medicaid will add the following procedure codes as noncovered procedure codes:

CAD Procedure Codes
C9309J1098J1553J9003Q0238Q5161    
Non-CAD Procedure Codes
A2040A2041A2042A2043A2044A2045A4318A4479A6548A8005
A8006A9294C1743G0680L5992M0233M0234Q4418Q4419Q4421
Q4422Q4423Q4424Q4425Q4426Q4427Q4428Q4429Q4435Q4436
Q4437Q4438Q4439Q4440      

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, J3404, J8502, J9183, J9278, J960118 years of age or older
J927712 years of age or older
L2221Birth through 20 years of age

Procedure codes C8007 and C8011 will require prior authorization. Refer to the current Texas Medicaid Provider Procedures Manual (TMPPM), Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.46.14, “Hypoglossal Nerve Stimulators (HNS),” for additional information.

Procedure code J3404 will require prior authorization. TMHP will publish the additional criteria in a future article.

Procedure code J9601 will be restricted to diagnosis codes C9000 and C9002.

Procedure code L2221 will require prior authorization. Refer to the current TMPPM, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.19.2, “Prior Authorization and Documentation Requirements,” for additional information.

Procedure Codes G0681, G0682, G0683, G0684

In a facility setting, all skin substitute products used in wound care services are considered part of the application services and are not separately reimbursed. In an office-based setting, it is considered for separate reimbursement when submitted with an appropriate application procedure code.

First Quarter 2026 HCPCS Discontinued Procedure Codes

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

Discontinued Procedure CodesDirect Replacement Procedure Codes
C9145J8502
C9307J9601
C9308J9278
Discontinued Procedure Codes With No Direct Replacement
L6000L6010L6020       

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

Texas Medicaid 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

Texas Medicaid will add the following procedure codes as benefits, pending a required rate hearing:

CAD Procedure Codes
J0681J3389J7528J9161J9174J9248Q5134Q5148Q5160 
Non-CAD Procedure Codes
87183G0567J7299       

The Healthy Texas Women (HTW) program will add procedure code J7299 as a benefit.

Note: Procedure code J7299 is a Medicaid-only benefit and is not covered by Medicare.

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
J3389Six years of age or older
J9161, J9248, Q5134, Q516018 years of age or older

Procedure codes J3389 and J9161 will require prior authorization. TMHP will publish the additional criteria in future articles.

Procedure code J9248 will be restricted to diagnosis codes C6930, C6931, C6932, C6940, C6941, and C6942.

Procedure code Q5134 will be restricted to the following diagnosis codes:

Diagnosis Codes
K50111K50114K50118K50918K50914K50919K50011K5080
K50013K50811K50018K50812K50112K50913K50813K5000
K50814K50014K50818K50113K5090K5010K50911K50012
K50912G35AG35C0G35DG35C1   

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.

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