The following tables show the section and handbooks that were changed in the Texas Medicaid Provider Procedures Manual. The changes are listed in reverse chronological order (newest first).
For changes that were made in 2025, see the 2025 Release Notes.
| April 2026 TMPPM Release Notes | |
|---|---|
| Handbook | Related Articles and Notes |
| Children’s Services Handbook: Texas Health Steps (THSteps) Dental services (Section 3) | Information posted January 30, 2026 Update to “Texas Health Steps Therapeutic Dental Services” in 2026 HCPCS Special Bulletin Information posted March 6, 2026 |
| Clinics and Other Outpatient Facility Services Handbook | Added additional facilities—birthing centers, local health departments, and maternity service clinics—to the introductory statement of section 1, “General Information.” Revised enrollment criteria in section 9.1, “Enrollment.” |
| Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook | Edited bullet in section 2.2.12.7.1 for CGM authorization requirements. |
| Healthy Texas Women (HTW) Program Handbook | TMPPM Update for HTW and Microbiology Procedure Code G0433 Information posted January 30, 2026 |
| Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | April 2026 TMPPM Update for Stereotactic Radiosurgery Information posted February 13, 2026 Corrected typo errors for reference to code 2C9 changed to 2C19, and procedure code 81227 changed to 81225, in subsection 9.2.43.1, "Testing of Polymorphic 2C19." In section 9.2.36.2, "Vaccine and Toxoid Procedure Codes," added asterisk to procedure code 90677 to note that the vaccine is available through Texas Vaccines for Children (TVFC). |
| Outpatient Drug Services Handbook | Updated Prior Authorization Criteria for Monoclonal Antibodies Effective April 1, 2026 Information posted February 27, 2026 Replaced URL link and updated the form name for Synagis in subsection 10.7.2.2, "Traditional Medicaid." Texas Medicaid Diagnosis Restrictions for Tocilizumab-bavi (Tofidence) Effective October 1, 2024 Information posted February 7, 2025 April 2026 Updates in the TMPPM Outpatient Drug Services Handbook Information posted March 13, 2026 Removed section 6.97, Pemivibart, procedure codes M0224 and Q0224 are not a benefit. Information posted March 6, 2026 |
| Radiology and Laboratory Services Handbook | TMPPM Update for HTW and Microbiology Procedure Code G0433 Information posted January 30, 2026 |
| School Health and Related Services (SHARS) Handbook | CMS Has Approved State Plan Amendment for SHARS Audiology Services Information posted March 6, 2026 |
| February 2026 TMPPM Release Notes | |
|---|---|
| Handbook | Related Articles and Notes |
| Volume 1: Section 3: TMHP Electronic Data Interchange (EDI) | Update to “TMHP EDI Onboarding and Testing Changes Effective December 31, 2025” Information posted December 23, 2025 |
| Volume 1: Section 4: Client Eligibility | Providers May Use Mother's Medicaid ID When Submitting Claims for Newborns Information posted December 1, 2025 |
| Children’s Services Handbook: Appendix B: Immunizations | HCPCS Annual Updates Effective January 1, 2026 Information posted December 31, 2025 |
| Children’s Services Handbook: Appendix F: THSteps Quick Reference Guide | HCPCS Annual Updates Effective January 1, 2026 Information posted December 31, 2025 |
| Children’s Services Handbook: Medical services (Sections 1-2 and 4-8) | HCPCS Annual Updates Effective January 1, 2026 Information posted December 31, 2025 |
| Clinics and Other Outpatient Facility Services Handbook | Updated section reference in Section 1, General Information for "Carve Out Services" in the Medicaid Managed Care handbook. |
| Healthy Texas Women (HTW) Program Handbook | HCPCS Annual Updates Effective January 1, 2026 Information posted December 31, 2025 |
| Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook | HCPCS Annual Updates Effective January 1, 2026 Information posted December 31, 2025 |
| Medical Transportation Program Handbook | Update to “TMHP EDI Onboarding and Testing Changes Effective December 31, 2025” Information posted December 23, 2025 |
| Outpatient Drug Services Handbook | Removed duplicate letter at the beginning of the word axatilimab-csfr in subsection 6.16.1, "Prior Authorization Requirements." Removed Emflaza HHS Form 1347 and Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors HHS Form 1355, and replaced the website link for the Clinical Prior Authorization Assistance Chart in section 13.1, "Clinical Prior Authorization." Removed text "on the PAXpress website" from the reference in section 13.3, "Obtaining Prior Authorization. HCPCS Annual Updates Effective January 1, 2026 Information posted December 31, 2025 Benefit information in Section 6.6, "Ajovy (fremanezumab-vfrm)" was moved to Section 6.26, "Calcitonin Gene–Related Peptide (CGRP) agents," and the duplicate subsection 6.26.2, "Fremanezumab-vfrm (Ajovy)," was replaced. Iron Injection Age Limitations to Be Updated for Texas Medicaid Information posted January 2, 2026 Removed all benefit information for immune globulin in section 6.66, Immune Globulin. Corrected diagnosis code in Section 6.59.1, “Darbepoetin Alfa” from D462 to D4621. |
| January 2026 TMPPM Release Notes | |
|---|---|
| Handbook | Related Articles and Notes |
| Volume 1: Section 4: Client Eligibility | Providers May Use Mother's Medicaid ID When Submitting Claims for Newborns Information posted December 1, 2025 |
| Volume 1: Section 6: Claims Filing | Providers May Use Mother's Medicaid ID When Submitting Claims for Newborns Information posted December 1, 2025 Updated claims filing deadline info for 2026. |
| Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook | TMPPM Update: Hospital Beds and Equipment Information posted November 14, 2025 |
| Medicaid Managed Care Handbook | Dual Demonstration MMP Program Ending on January 1, 2026 Information posted November 14, 2025 |
| Outpatient Drug Services Handbook | Revised text in first sentence of section 6.42, "Elivaldogene Autotemcel (Skysona") from "ae" to "as is".) Submitting Claims for HCCAD Skysona With U3 Modifier (Procedure Code J3590) Information posted December 2, 2025 Changes to Hepatitis C Agents Drug Class Effective January 2026 Information posted November 26, 2025 Texas Medicaid Prior Authorization Update for Clofarabine Effective January 1, 2026 Information posted November 21, 2025 Removed all benefit information from section 6.73, "Interferon," from the Outpatient Drug Services handbook. Removed duplicate text "lovotibeglogene autotemcel" in the fifth statement listed in section 6.114, "Sickle Cell Disease Gene Therapy." Fixed indention at the beginning of some statements in the following sections: 10.3.1, "Background on Hepatitis C," 10.3.2, "HCV Screening and Testing," 10.3.3, "Treatment Coverage," 10.3.4, "Follow-Up After Treatment," 10.3.5, "Pregnant Clients," and 10.3.6, "Resources for Providers." Replaced broken URL link for Synagis in the table of section 13.1, "Clinical Prior Authorization." Replaced broken web page link for Prescriber Resources in section 10.3.6, "Resources for Providers." |
| Vision and Hearing Services Handbook | Updated payable provider type information for ear and throat examination procedure codes in section 2.2.3.7.4 to reflect current policy. |