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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| C9818 | J0463 | J1164 | J3404 | J8502 | J9183 | J9277 | J9278 | J9601 | Q5162 |
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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| C8007 | C8008 | C8009 | C8010 | C8011 | C8012 | C8013 | G0681 | G0682 | G0683 |
| G0684 | L2221 | ||||||||
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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| C9309 | J1098 | J1553 | J9003 | Q0238 | Q5161 | ||||
| Non-CAD Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| A2040 | A2041 | A2042 | A2043 | A2044 | A2045 | A4318 | A4479 | A6548 | A8005 |
| A8006 | A9294 | C1743 | G0680 | L5992 | M0233 | M0234 | Q4418 | Q4419 | Q4421 |
| Q4422 | Q4423 | Q4424 | Q4425 | Q4426 | Q4427 | Q4428 | Q4429 | Q4435 | Q4436 |
| Q4437 | Q4438 | Q4439 | Q4440 | ||||||
The following procedure codes are not benefits because they are considered part of another service:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| A2040 | A2041 | A2042 | A2043 | A2044 | A2045 | Q4418 | Q4419 | Q4421 | Q4422 |
| Q4423 | Q4424 | Q4425 | Q4426 | Q4427 | Q4428 | Q4429 | Q4435 | Q4436 | Q4437 |
| Q4438 | Q4439 | Q4440 | |||||||
Additional Benefit Information
Age limitations will apply for the following procedure codes:
| Procedure Codes | Client Age Limitation |
|---|---|
| C9818, J1164, J3404, J8502, J9183, J9278, J9601 | 18 years of age or older |
| J9277 | 12 years of age or older |
| L2221 | Birth 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 Codes | Direct Replacement Procedure Codes |
|---|---|
| C9145 | J8502 |
| C9307 | J9601 |
| C9308 | J9278 |
| Discontinued Procedure Codes With No Direct Replacement | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| L6000 | L6010 | L6020 | |||||||
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 Codes | Effective Date |
|---|---|
| A2014 | October 1, 2022 |
| A2037 | October 1, 2025 |
| J0174 | July 6, 2023 |
| L6028 | April 1, 2025 |
First Quarter 2026 HCPCS Informational Procedure Codes
Texas Medicaid will add the following procedure codes as informational only:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 0614U | 0615U | 0616U | 0617U | 0618U | 0619U | 0620U | 0621U | 0622U | 0623U |
| 0624U | 0625U | 0626U | 0627U | 0628U | 0629U | 0630U | |||
CMS will revise the descriptions of the following informational procedure codes:
| Procedure Codes | Effective Date |
|---|---|
| 0256U | October 1, 2021 |
| 0580U | October 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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| J0681 | J3389 | J7528 | J9161 | J9174 | J9248 | Q5134 | Q5148 | Q5160 | |
| Non-CAD Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 87183 | G0567 | J7299 | |||||||
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 Codes | Client Age Limitation |
|---|---|
| J3389 | Six years of age or older |
| J9161, J9248, Q5134, Q5160 | 18 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 | |||||||
|---|---|---|---|---|---|---|---|
| K50111 | K50114 | K50118 | K50918 | K50914 | K50919 | K50011 | K5080 |
| K50013 | K50811 | K50018 | K50812 | K50112 | K50913 | K50813 | K5000 |
| K50814 | K50014 | K50818 | K50113 | K5090 | K5010 | K50911 | K50012 |
| K50912 | G35A | G35C0 | G35D | G35C1 | |||
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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