On September 30, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the third quarter 2026 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after October 1, 2026. This article details the HCPCS updates.
Third Quarter 2026 HCPCS Added Procedure Codes
All new benefits must go through the Texas Medicaid rate hearing process to allow public comment on proposed reimbursement rates. The Children with Special Health Care Needs (CSHCN) Services Program must review the adopted Texas Medicaid rates to determine whether they are fiscally feasible for the program.
Note: The CSHCN Services Program may adopt temporary or interim rates for procedure codes before the rate hearing process is complete. TMHP will deny any claims until they’ve implemented a rate or an interim rate for a procedure code. After the rate is implemented, TMHP may process any affected claims according to the Centers for Medicare & Medicaid Services (CMS) effective date.
After the rate hearing, the CSHCN Services Program 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 CSHCN Services Program will add the following procedure codes as benefits pending the required Texas Medicaid rate hearing:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 87638 | J0643 | J1957 | J1958 | J3268 | J7524 | J7526 | J7529 | J7530 | J7531 |
| J9187 | J9192 | L1972 | L8697 | ||||||
Note: Procedure code 87638 will be effective for dates of service on or after May 15, 2026. Providers can refer to the Rate and Code Updates – Required CLIA Lab Certifications page on tmhp.com for the required laboratory certifications for procedure code 87638.
Effective October 1, 2026, the CSHCN Services Program will add the following procedure codes as noncovered procedure codes:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| A2046 | A2047 | A2048 | A2049 | A2050 | A4228 | A6614 | A9613 | C9311 | C9312 |
| C9313 | E0788 | E2403 | G0685 | J0014 | J0644 | J0871 | J1757 | J1818 | J1946 |
| J1947 | J3406 | J9066 | J9186 | J9191 | J9362 | L1330 | Q4207 | Q4223 | Q4243 |
| Q5172 | Q5173 | ||||||||
The following procedure codes are not benefits because they are considered part of another service:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| A2046 | A2047 | A2048 | A2049 | A2050 | A9613 | Q4207 | Q4223 | Q4243 | |
Additional Benefit Information
Age limitations will apply for the following procedure codes:
| Procedure Code | Client Age Limitation |
|---|---|
| J1958 | 16 years of age or older |
| J3268 | 18 years of age or older |
| L1972 | Birth through 20 years of age |
Procedure code L1972 will require prior authorization. Refer to the current CSHCN Services Program Provider Manual, “Orthotic and Prosthetic Devices,” subsection 28.3.6, “Lower-Limb Orthoses,” for additional information.
Third Quarter 2026 HCPCS Discontinued Procedure Codes
Effective October 1, 2026, CMS will discontinue the following procedure codes:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 0556U | 0557U | 0585U | C8010 | C9046 | C9310 | C9462 | J0640 | J1941 | J1953 |
| J7514 | J7517 | J7519 | J7528 | J9181 | J9190 | J9352 | L8696 | ||
Claims for discontinued procedure codes will not be reimbursed after September 30, 2026.
Third Quarter 2026 HCPCS Revised Procedure Codes
CMS will revise the descriptions of the following procedure codes:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| A9595 | C1982 | C8004 | C9797 | J3300 | J9033 | L1971 | L8030 | L8031 | L8035 |
| S0169 | |||||||||
Third Quarter 2026 HCPCS Informational Procedure Codes
The CSHCN Services Program will add the following procedure codes as informational only:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 0660U | 0661U | 0662U | 0663U | 0664U | 0665U | 0666U | 0667U | 0668U | 0669U |
| 0670U | 0671U | 0672U | 0673U | 0674U | 0675U | 0676U | 0677U | 0678U | 0679U |
| 0680U | 0681U | 0682U | 0683U | 0684U | 0685U | 0686U | 0687U | 0688U | 0689U |
| 0690U | 0691U | 0692U | 0693U | 0694U | 0695U | 0696U | 0697U | 0698U | 1054T |
| 1055T | 1056T | 1057T | 1058T | 1059T | 1060T | 1061T | 1062T | 1063T | 1064T |
| 1065T | 1066T | 1067T | 1068T | 1069T | 1070T | 1071T | 1072T | 1073T | 1074T |
| 1075T | 1076T | 1077T | 1078T | 1079T | 1080T | 1081T | 1082T | 1083T | 1084T |
| 1085T | 1086T | 1087T | 1088T | 1089T | 1090T | 1091T | 1092T | 1093T | 1094T |
| 1095T | 1096T | 1097T | 1098T | 1099T | 1100T | 1101T | 1102T | 1103T | 1104T |
| 1105T | 1106T | 1107T | 1108T | 1109T | 1110T | 1111T | |||
CMS will revise the descriptions of the following informational procedure codes:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 0247U | 0591U | 0600U | 0601U | 0602U | 0603U | 0604U | 0605U | 0606U | 0607U |
| 0608U | 0609U | 0610U | 0611U | 0612U | 0613U | 0614U | 0615U | 0616U | 0617U |
| 0618U | 0619U | 0620U | 0621U | 0622U | 0623U | 0624U | 0625U | 0626U | 0627U |
| 0628U | 0629U | 0630U | 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 | 0894T | 0895T | 0896T | |||||
Updates for Procedure Codes From a Previous Quarter
The CSHCN Services Program will add the following procedure codes as benefits, pending a required rate hearing:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| J7176 | Q5161 | ||||||||
Additional Benefit Information
Procedure code Q5161 will be limited to clients who are 12 years of age or older.
For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.