April 2026 HCPCS Updates to Affect CSHCN Program Benefits and Reimbursement

Feb 23, 2026

1 minute

April 2026 HCPCS Updates to Affect CSHCN Program Benefits and Reimbursement

The Texas Medicaid & Healthcare Partnership (TMHP) has announced upcoming updates to procedure codes under the Children with Special Health Care Needs (CSHCN) Services Program, effective April 1, 2026.

The changes are based on the first-quarter 2026 revisions to the Healthcare Common Procedure Coding System (HCPCS) issued by the Centers for Medicare & Medicaid Services (CMS). These updates include the addition of new procedure codes, revisions to existing codes, and the discontinuation of certain codes.

Newly added HCPCS codes will not be immediately reimbursable under the CSHCN Services Program. The Texas Health and Human Services Commission (HHSC) must first review the new codes and conduct a rate hearing before reimbursement rates are established. Providers will receive formal notification of any benefit updates in a future publication.

For further assistance, providers may contact the TMHP-CSHCN Services Program Contact Center at 800-568-2413.

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Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

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Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

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RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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