Texas Medicaid Issues Update on Procedure Code L6028 Reimbursement

Apr 03, 2026

1 minute

Texas Medicaid Issues Update on Procedure Code L6028 Reimbursement

Texas Medicaid has released an important clarification regarding reimbursement policies for procedure code L6028, impacting prosthetist and orthotist providers.

Effective March 26, 2026, procedure code L6028 has been officially recognized as a payable benefit for prosthetist providers, applicable to dates of service on or after April 1, 2025. Additionally, the code remains a payable benefit for durable medical equipment (DME) suppliers.

However, Texas Medicaid identified a processing discrepancy affecting claims submitted on or after April 1, 2026. Due to this issue, some claims may have been incorrectly reimbursed to orthotist providers while being erroneously denied for prosthetist providers. The agency has clarified that orthotist providers are not eligible for reimbursement under procedure code L6028.

To address this error, Texas Medicaid has confirmed that all affected claims will be systematically reprocessed. Any resulting recoupments or additional reimbursements will be reflected in the upcoming Remittance and Status (R&S) Reports.

Providers are advised to monitor their reports closely for adjustments related to this update. For further assistance or clarification, providers may contact the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 800-925-9126.

This update underscores the importance of accurate provider classification in claims submission and ongoing vigilance in reviewing reimbursement reports.

Services

Credentialing

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.

Eligibility Verification

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.

Revenue Cycle Management

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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