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

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Effective for dates of service on or after January 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will implement reimbursement rate updates for certain Healthcare Common Procedure Coding System (HCPCS) procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program.

Providers can view the updates in the following spreadsheets:

Claims Reprocessing

TMHP will identify and reprocess any claims that have been affected by this update. If there are any adjustments to claims reimbursement amounts, they will appear on future Remittance and Status (R&S) Reports.

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