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Second Quarter 2026 HCPCS Updates for Texas Medicaid

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On June 30, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the second quarter 2026 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2026. This article details the HCPCS updates.

Second Quarter 2026 HCPCS Added Procedure Codes

Clinician-Administered Drug (CAD) Procedure Codes
C9310J0528J1289J1577J2361J2374J2789J3405J9053J9062
J9232Q5164Q5167       

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, July 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 July 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 Code
C8014         

Texas Medicaid will add the non-CAD procedure code listed in the table above as a benefit 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.

The Healthy Texas Women (HTW) Program will add the following procedure code as a benefit:

Procedure Code for HTW and HTW Plus
J0528         

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

CAD Procedure Codes
J3386J7176Q5165Q5166Q5168Q5169Q5170Q5171  
Non-CAD Procedure Codes
9061690639A9574C1609G0574G0575G0577G0669G0670G0671
G0672G0673G0674G0675G0676G0677G0678M0231M0232Q0234

The following procedure code is not a benefit because it is considered part of another service:

Procedure Code
A9574         

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
J0528, J1577, J9053, J906218 years of age or older
J1289, J34052 years of age or older
J236112 years of age or older
J2374, Q51646 years of age or older
J278913 years of age or older

Procedure code C8014 will be restricted to the following diagnosis codes:

Diagnosis Codes
N132N200N201N202N209N210N211N218
N219N23      

Procedure code J2361 will be restricted to the following diagnosis codes:

Diagnosis Codes
J4550J4551J8283     

Procedure code J3405 will be restricted to the following diagnosis codes:

Diagnosis Codes
G120G121G1225G128G129   

Procedure code J9053 will be restricted to diagnosis codes C9000 and C9002.

Procedure code Q5164 will be restricted to the following diagnosis codes:

Diagnosis Codes
K5000K50011K50012K50013K50014K50018K50019K5010
K50111K50112K50113K50114K50118K50119K5080K50811
K50812K50813K50814K50818K50819K5090K50911K50912
K50913K50914K50918K50919K5100K51011K51012K51013
K51014K51018K51019K5120K51211K51212K51213K51214
K51218K51219K5130K51311K51312K51313K51314K51318
K51319K5180K51811K51812K51813K51814K51818K51819
K5190K51911K51912K51913K51914K51918K51919L400
L401L402L403L404L4050L4051L4052L4053
L4054L4059L408L409    

Second Quarter 2026 HCPCS Discontinued Procedure Codes

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

Procedure Codes
0029U0031U0423U0577UC9309     

Claims for discontinued procedure codes will not be reimbursed after June 30, 2026.

Second Quarter 2026 HCPCS Revised Procedure Codes

CMS will revise the descriptions of the following procedure codes:

Procedure Codes
63661A4459A4479C9761C9809J1569J2787J3375  

Second Quarter 2026 HCPCS Informational Procedure Codes

Texas Medicaid will add the following procedure codes as informational only:

Procedure Codes
0631U0632U0633U0634U0635U0636U0637U0638U0639U0640U
0641U0642U0643U0644U0645U0646U0647U0648U0649U0650U
0651U0652U0653U0654U0655U0656U0657U0658U0659U1026T
1027T1028T1029T1030T1031T1032T1033T1034T1035T1036T
1037T1038T1039T1040T1041T1042T1043T1044T1045T1046T
1047T1048T1049T1050T1051T1052T1053T   

CMS will revise the descriptions of the following informational procedure codes:

Procedure Codes
0522U0805T0806T0882T0883T     

Second Quarter 2026 HCPCS Modifier Updates

ModifierAction
ACADD

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
J1737J9249J9275       

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure CodesClient Age Limitation
J1737, J927518 years of age or older

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.