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
| Clinician-Administered Drug (CAD) Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| C9311 | C9313 | J0643 | J0644 | J0871 | J1757 | J1818 | J1946 | J1947 | J1957 |
| J1958 | J3268 | J3406 | J7524 | J7526 | J7529 | J7530 | J7531 | J9186 | J9187 |
| J9191 | J9192 | J9362 | Q5172 | ||||||
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, October 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 October 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 Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 87638 | A4228 | E0788 | 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.
Texas Medicaid will add the non-CAD procedure codes listed in the table above as benefits 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 Plus Only | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| J7531 | |||||||||
Effective October 1, 2026, Texas Medicaid will add the following procedure codes as noncovered procedure codes:
| CAD Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| C9312 | J9066 | Q5173 | |||||||
| Non-CAD Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| A2046 | A2047 | A2048 | A2049 | A2050 | A6614 | A9613 | E2403 | G0685 | J0014 |
| L1330 | Q4207 | Q4223 | Q4243 | ||||||
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 Codes | Client Age Limitation |
|---|---|
| C9311, C9313, J1946, J3268, J9186, J9362 | 18 years of age or older |
| J1818 | 2 years of age or older |
| J1947 | 6 years of age or older |
| J3406 | 12 years of age or older |
| L1972 | Birth through 20 years of age |
Procedure code J3406 will require prior authorization and replaces procedure code J3590 when submitting claims for omidubicel-onlv (Omisirge). Refer to the current TMPPM, Outpatient Drug Services Handbook, subsection 6.96.1, “Prior Authorization Requirements,” for additional information.
Procedure code L1972 will require prior authorization. Refer to the current TMPPM, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.19.2, “Prior Authorization and Documentation Requirements,” for additional information.
Procedure code A4228 will require prior authorization. Refer to the current Texas Medicaid Provider Procedures Manual (TMPPM), Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsections 2.2.16.1, “Prior Authorization,” and 2.2.16.2 “Documentation Requirements,” for additional information.
The following procedure codes will be diagnosis-restricted:
| Procedure Codes | Diagnosis Restrictions |
|---|---|
| C9311 | E851 |
| C9313 | C864 |
| E0788 | G20A1, G20A2, G20B1, G20B2, G20C |
| J1757 | E761 |
| J1818 | E7221 |
| J1946, J1947 | I501, I5020, I5022, I5023, I5030, I5032, I5033, I5040, I5042, I5043, I50810, I50812, I50813, I50814, I5082, I5083, I5084, I5089, I509 |
Procedure codes J7524, J7526, J7529, and J7530 may be indicated for, but are not limited to, treatment for prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants.
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
Texas Medicaid 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
Texas Medicaid will add the following procedure codes as benefits, pending a required rate hearing:
| CAD Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| J1749 | J3424 | J7176 | Q5161 | Q5168 | Q5169 | ||||
Texas Medicaid will add the following procedure codes as informational only, effective for dates of service on or after July 1, 2026:
| Procedure Codes | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| M0231 | M0232 | Q0234 | |||||||
Additional Benefit Information
Age limitations will apply for the following procedure codes:
| Procedure Codes | Client Age Limitation |
|---|---|
| J1749, J3424, Q5168 | 18 years of age or older |
| Q5161 | 12 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.