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Reimbursement Rate Updates for Radiation Oncology Procedure Codes Effective January 1, 2026

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The Texas Medicaid & Healthcare Partnership (TMHP) will implement the reimbursement rate updates for radiation oncology procedure codes that were presented at the public rate hearing on April 24, 2026, for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. The updates will be effective for dates of service on or after January 1, 2026.

To view the updates, access the Radiation Oncology 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 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.

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.