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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| C9310 | J0528 | J1289 | J1577 | J2361 | J2374 | J2789 | J3405 | J9053 | J9062 |
| J9232 | Q5164 | Q5167 | |||||||
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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| J3386 | J7176 | Q5165 | Q5166 | Q5168 | Q5169 | Q5170 | Q5171 | ||
| Non-CAD Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 90616 | 90639 | A9574 | C1609 | G0574 | G0575 | G0577 | G0669 | G0670 | G0671 |
| G0672 | G0673 | G0674 | G0675 | G0676 | G0677 | G0678 | M0231 | M0232 | Q0234 |
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 Codes | Client Age Limitation |
|---|---|
| J0528, J1577, J9053, J9062 | 18 years of age or older |
| J1289, J3405 | 2 years of age or older |
| J2361 | 12 years of age or older |
| J2374, Q5164 | 6 years of age or older |
| J2789 | 13 years of age or older |
Procedure code C8014 will be restricted to the following diagnosis codes:
| Diagnosis Codes | |||||||
|---|---|---|---|---|---|---|---|
| N132 | N200 | N201 | N202 | N209 | N210 | N211 | N218 |
| N219 | N23 | ||||||
Procedure code J2361 will be restricted to the following diagnosis codes:
| Diagnosis Codes | |||||||
|---|---|---|---|---|---|---|---|
| J4550 | J4551 | J8283 | |||||
Procedure code J3405 will be restricted to the following diagnosis codes:
| Diagnosis Codes | |||||||
|---|---|---|---|---|---|---|---|
| G120 | G121 | G1225 | G128 | G129 | |||
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 | |||||||
|---|---|---|---|---|---|---|---|
| K5000 | K50011 | K50012 | K50013 | K50014 | K50018 | K50019 | K5010 |
| K50111 | K50112 | K50113 | K50114 | K50118 | K50119 | K5080 | K50811 |
| K50812 | K50813 | K50814 | K50818 | K50819 | K5090 | K50911 | K50912 |
| K50913 | K50914 | K50918 | K50919 | K5100 | K51011 | K51012 | K51013 |
| K51014 | K51018 | K51019 | K5120 | K51211 | K51212 | K51213 | K51214 |
| K51218 | K51219 | K5130 | K51311 | K51312 | K51313 | K51314 | K51318 |
| K51319 | K5180 | K51811 | K51812 | K51813 | K51814 | K51818 | K51819 |
| K5190 | K51911 | K51912 | K51913 | K51914 | K51918 | K51919 | L400 |
| L401 | L402 | L403 | L404 | L4050 | L4051 | L4052 | L4053 |
| L4054 | L4059 | L408 | L409 | ||||
Second Quarter 2026 HCPCS Discontinued Procedure Codes
Effective July 1, 2026, CMS will discontinue the following procedure codes:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 0029U | 0031U | 0423U | 0577U | C9309 | |||||
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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 63661 | A4459 | A4479 | C9761 | C9809 | J1569 | J2787 | J3375 | ||
Second Quarter 2026 HCPCS Informational Procedure Codes
Texas Medicaid will add the following procedure codes as informational only:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 0631U | 0632U | 0633U | 0634U | 0635U | 0636U | 0637U | 0638U | 0639U | 0640U |
| 0641U | 0642U | 0643U | 0644U | 0645U | 0646U | 0647U | 0648U | 0649U | 0650U |
| 0651U | 0652U | 0653U | 0654U | 0655U | 0656U | 0657U | 0658U | 0659U | 1026T |
| 1027T | 1028T | 1029T | 1030T | 1031T | 1032T | 1033T | 1034T | 1035T | 1036T |
| 1037T | 1038T | 1039T | 1040T | 1041T | 1042T | 1043T | 1044T | 1045T | 1046T |
| 1047T | 1048T | 1049T | 1050T | 1051T | 1052T | 1053T | |||
CMS will revise the descriptions of the following informational procedure codes:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 0522U | 0805T | 0806T | 0882T | 0883T | |||||
Second Quarter 2026 HCPCS Modifier Updates
| Modifier | Action |
|---|---|
| AC | ADD |
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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| J1737 | J9249 | J9275 | |||||||
Additional Benefit Information
Age limitations will apply for the following procedure codes:
| Procedure Codes | Client Age Limitation |
|---|---|
| J1737, J9275 | 18 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.