Texas Medicaid Announces Reimbursement Rate Updates for HCPCS Codes
The Texas Medicaid & Healthcare Partnership (TMHP) has announced updated reimbursement rates for select Healthcare Common Procedure Coding System (HCPCS) procedure codes under Texas Medicaid. These changes will take effect for dates of service on or after January 1, 2026.
Scope of the Update
The revised reimbursement rates apply across multiple service categories. Providers can review detailed changes through official TMHP spreadsheets covering:
- Ambulatory Surgical Center TOS F
- Clinical Diagnostic Laboratory Services TOS 5
- Dental TOS W
- Drugs TOS 1
- Durable Medical Equipment TOS 9-J-L
- Non-Drugs TOS 1
- Radiation Therapy TOS 6-I-T
- Radiology TOS 4 Non-Rural
- Radiology TOS 4 Rural
- Radiology TOS 4-I-T
- Surgery and Assistant Surgery TOS 2-8
Claims Reprocessing
TMHP will automatically identify and reprocess claims impacted by these reimbursement updates. Any resulting adjustments in payment amounts will be reflected in upcoming Remittance and Status (R&S) reports, ensuring providers receive corrected reimbursements without requiring resubmission.
Managed Care Considerations
While these updates apply to traditional fee-for-service Medicaid, providers should note that Medicaid managed care organizations (MCOs) operate under separate administrative procedures. Requirements such as prior authorization, referrals, and claims submission may vary between MCOs.
Healthcare providers are advised to contact the specific MCO associated with a member for detailed guidance on administrative processes and coverage policies.
Additional Information
For further assistance or clarification, providers can contact the TMHP Contact Center at 800-925-9126.
