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Reimbursement Rate Updates for Certain CSHCN Services Program HCPCS Drug Procedure Codes Effective January 1, 2026

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The Texas Medicaid & Healthcare Partnership (TMHP) has revised the reimbursement rates for Healthcare Common Procedure Coding System (HCPCS) drug procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program.

The new rates are effective for all claims with dates of service on or after January 1, 2026.

Providers can view the updates in the Drug Procedure Codes spreadsheet.

Claims Reprocessing

TMHP will identify and reprocess any claims that have been affected by this update. Any adjustments to claims reimbursement amounts will appear in future Remittance and Status (R&S) Reports.

For more information, call the TMHP Contact Center at 800-925-9126.